Built environment configuration and change in body mass index: The Caerphilly Prospective Study (CaPS)

Effect of built environment on BMI of older adults in regions of different socio-economic statuses

Background

Numerous studies have ignored the influence of underdeveloped urban surroundings on the physical health of China's ageing population. Lanzhou is a typical representative of a less developed city in China.

Methods

This study investigated the relationship between body mass index (BMI) and built environment amongst older adults in regions of different socio-economic statuses (SES) using data from medical examinations of older adults in Lanzhou, as well as calculating community built environment indicators for regions of different SES based on multiple linear regression models.

Results

Results showed that age and underlying disease were negatively associated with overall older adult BMI in the study buffer zone. Land use mix, number of parks and streetscape greenery were positively associated with older adult BMI. Street design and distance to bus stops were negatively connected in low SES regions, but population density and street design were negatively correlated in high SES areas.

Conclusion

These findings indicate that the built environment of SES regions has varying impacts on the BMI of older persons and that planners may establish strategies to lower the incidence of obesity amongst older adults in different SES locations.

Neighbourhood socioeconomic disadvantage and body size in Australia's capital cities: The contribution of obesogenic environments

Residents of socioeconomically disadvantaged neighbourhoods have higher rates of overweight and obesity and chronic disease than their counterparts from advantaged neighbourhoods. This study assessed whether associations between neighbourhood disadvantage and measured body mass index (BMI) and waist circumference, are accounted for by obesogenic environments (i.e., residential distance to the Central Business District [CBD], supermarket availability, access to walkable destinations). The study used 2017-18 National Health Survey data for working-aged adults (aged ≥18 years, n = 9,367) residing in 3,454 neighbourhoods across Australia's state and territory capital cities. In five of eight cities (i.e., Sydney, Melbourne, Brisbane, Adelaide, and Perth) residents of disadvantaged neighbourhoods had significantly higher BMI and a larger waist circumference than residents of more advantaged areas. There was no association between neighbourhood disadvantage and body size in Hobart, Darwin, and Canberra. Associations between neighbourhood disadvantage and body size were partially explained by neighbourhood differences in distance to the CBD but not supermarket availability or walkable amenities. The results of this study point to the role of urban design and city planning as mechanisms for addressing social and economic inequities in Australia's capital cities, and as solutions to this country's overweight and obesity epidemic and associated rising rates of chronic disease.

Spatial uncertainty and environment-health association: An empirical study of osteoporosis among "old residents" in public housing estates across a hilly environment

BACKGROUND

Built environment can influence physical conditions of older adults (e.g. osteoporosis). However, traditional methods using 2-dimensional circular buffer as a spatial structure to measure neighbourhood effect may create bias in health estimation, especially for the hilly and compact environment across low-income neighbourhoods (e.g. public housing estates).

METHODS

We evaluated the environmental influences on self-reported osteoporosis among "old residents" (age≥65) in Hong Kong (n = 2077). Twelve public housing estates across hilly neighbourhoods in Hong Kong were selected as study sites. A cross-validated approach was developed to evaluate four spatial structures (2D circular, 2D service area, 3D circular, 3D service area). To determine problems of spatial uncertainty, we compared odds ratios (OR) and differences in effect sizes from models using different spatial structures. When all adjusted models achieve significant results based on 95% confidence intervals (CI) and with all positive/negative ORs, this study reported to have reached "a result with consistency". Results from the 3D service area were then used to explain the environment-health relationship.

RESULTS

Different spatial structures can yield different results. Particularly, circular buffers overestimated environmental effects on self-reported osteoporosis. Overestimated measures were related to walkability and accessibility but not greenery. Specifically, results from the 3D service area showed that more public space and health facilities within a walkable distance (500 m) from a location of subject's residence were negatively associated with self-reported osteoporosis (adjusted ORs: 0.44 [0.29, 0.66]; 0.94 [0.90, 0.99]). However, more major transport facilities at the immediate distance from residence (200 m) was positively associated with self-reported osteoporosis (adjusted OR: 1.11 [1.01, 1.23]).

CONCLUSIONS

Physical conditions (e.g. osteoporosis) of older adults living in a hilly neighbourhood could be driven by walking behaviours. It is necessary to include local terrain and road network to define a walkable neighbourhood for environment-health estimations to minimize spatial bias.

Exploring the Relationship Between Neighborhood-Built Environment and Elderly Health: A Research Based on Heterogeneity of Age and Gender Groups in Beijing

Background

The built environment quality of neighborhoods has a significant impact on the health of the elderly. Although there has been a wealth of studies on low-density Western cities, research on the impacts of built environment on elderly health in high-density Chinese cities is far from sufficient. The pathways by which the built environment affects elderly health remain to be observed, particularly whether such pathways vary for different ages and genders.

Methods

Based on the data of the "Fourth Survey on the Living Conditions of the Elderly in China" in 2015, a sample survey of 3,360 older adults, aged 60 years and over, in Beijing was conducted. We first explored the built environment factors that affect elderly health with a multilevel regression model. We then adopted a multilevel structural equation model (MSEM) to reveal the mediating effect of health activities. Moreover, a stratified analysis was applied to explore the impact of age and gender heterogeneity on the relationship between built environment and elderly health.

Results

(1) Neighborhood-built environment measured within a 500 m buffer area had a higher correlation with elderly health when compared with other areas. (2) Physical activity and social interaction played a mediating role in the correlation between the built environment and elderly health. Even if the interference of residential self-selection was controlled within the subgroups, majority of the built environment elements had significant impacts on elderly health. (3) The impacts of built environment variables on elderly health vary among different age and gender groups. Population density mainly promoted elderly health through health activities in the middle-aged (aged 70-79) group and high-aged (aged 80+) group, and shorter distance to transit stations affects health by promoting the social interaction among high-aged males (aged 80+) group compared to with other groups, and high-quality built environment significantly promotes physical activity to alleviate loneliness only in elderly females.

Conclusion

To effectively boost elderly health by improving the quality of the built environment, adequate considerations should also be given to the differentiated demands of adults of different age and gender groups, precise health behavior interventions should be provided, and the construction of personalized aging-friendly and livable spatial environments should be emphasized to realize healthy and active aging.

A longitudinal examination of objective neighborhood walkability, body mass index, and waist circumference: the REasons for Geographic And Racial Differences in Stroke study

Background

Studies have shown neighborhood walkability is associated with obesity. To advance this research, study designs involving longer follow-up, broader geographic regions, appropriate neighborhood characterization, assessment of exposure length and severity, and consideration of stayers and movers are needed. Using a cohort spanning the conterminous United States, this study examines the longitudinal relationship between a network buffer-derived, duration-weighted neighborhood walkability measure and two adiposity-related outcomes.

Methods

This study included 12,846 Black/African American and White adults in the REasons for Geographic And Racial Differences in Stroke study. Body mass index (BMI) and waist circumference (WC) were assessed at baseline and up to 13.3 years later (M (SD) = 9.4 (1.0) years). BMI and WC were dichotomized. Walk Score® was duration-weighted based on time at each address and categorized as Very Car-Dependent, Car-Dependent, Somewhat Walkable, Very Walkable, and Walker’s Paradise. Unadjusted and adjusted logistic regression models tested each neighborhood walkability-adiposity association. Adjusted models controlled for demographics, health factors, neighborhood socioeconomic status, follow-up time, and either baseline BMI or baseline WC. Adjusted models also tested for interactions. Post-estimation Wald tests examined whether categorical variables had coefficients jointly equal to zero. Orthogonal polynomial contrasts tested for a linear trend in the neighborhood walkability-adiposity relationships.

Results

The odds of being overweight/obese at follow-up were lower for residents with duration-weighted Walk Score® values in the Walker’s Paradise range and residents with values in the Very Walkable range compared to residents with values in the Very Car-Dependent range. Residents with duration-weighted Walk Score® values classified as Very Walkable had significantly lower odds of having a moderate-to-high risk WC at follow-up relative to those in the Very Car-Dependent range. For both outcomes, the effects were small but meaningful. The negative linear trend was significant for BMI but not WC.

Conclusion

People with cumulative neighborhood walkability scores in the Walker’s Paradise range were less likely to be overweight/obese independent of other factors, while people with scores in the Very Walkable range were less likely to be overweight/obese and less likely to have a moderate-to-high risk WC. Addressing neighborhood walkability is one approach to combating obesity.

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.

Research on the Difference Between Recreational Walking and Transport Walking Among the Elderly in Mega Cities With Different Density Zones: The Case of Guangzhou City

Walking is the easiest method of physical activity for older people, and current research has demonstrated that the built environment is differently associated with recreational and transport walking. This study modelled the environmental characteristics of three different building density zones in Guangzhou city at low, medium, and high densities, and examined the differences in walking among older people in the three zones. The International Physical Activity Questionnaire (IPAQ) was used to investigate the recreational and transport walking time of older people aged 65 years and above for the past week, for a total of three density zones (N = 597) and was analysed as a dependent variable. Geographic Information Systems (GIS) was used to identify 300, 500, 800, and 1,000 m buffers and to assess differences between recreational and transport walking in terms of the built environment [e.g., land-use mix, street connectivity, Normalised Difference Vegetation Index (NDVI) data]. The data were processed and validated using the SPSS software to calculate Pearson's correlation models and stepwise regression models between recreation and transit walking and the built environment. The results found that land use mix and NDVI were positively correlated with transport walking in low-density areas and that transport walking was negatively correlated with roadway mediated centrality (BtE) and Point-of-Interest (PoI) density. Moreover, recreational walking in medium density areas was negatively correlated with self-rated health, road intersection density, and PoI density while positively correlated with educational attainment, population density, land use mix, street connectivity, PoIs density, and NDVI. Transport walking was negatively correlated with land-use mix, number of road crossings while positively correlated with commercial PoI density. Street connectivity, road intersection density, DNVI, and recreational walking in high-density areas showed negative correlations. Moreover, the built environment of older people in Guangzhou differed between recreational and transport walking at different densities. The richness of PoIs has different effects on different types of walking.

Obesity and Natural Spaces in Adults and Older People: A Systematic Review

BACKGROUND

Obesity is an important public health issue that has increased globally in the last decade and continues to be one of the main causes of morbidity and premature mortality. An accumulating body of evidence suggests that contact with nature is a valuable resource for the promotion of a more active lifestyle and seems to have a central role in maintaining a healthy weight. The authors conducted a systematic review to summarize the findings of studies that investigated the relationship between natural spaces and obesity.

METHODS

Following Primary Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was conducted using 11 databases for studies fully available in English and published between 2010 and 2020, with adults (18-64 y) and/or older people (≥65 y).

RESULTS

Fifty studies were found that met all the inclusion criteria. The majority (68%) of papers found that higher availability and less distance to green and blue spaces are associated with lower levels of adiposity. These associations were positive, even after adjusting for the demographic and socioeconomic factors.

CONCLUSIONS

Exploring the characteristics of green and blue spaces seems to be a promising tool for urban planning and health policies. The authors suggest the implementation of exercise programs in contact with nature for future interventions.

Accessibility and Connectivity Criteria for Assessing Walkability: An Application in Qazvin, Iran

Distance is a recognized key determinant of walking. Pedestrians tend to choose the shortest route between two points. Shortest routes can be spatially described in terms of distances between two points or topologically described as the number of turns/directional changes between these points. This paper presents a methodology to evaluate the conditions provided by a street network to pedestrians, by using two space syntax measures. Accessibility was calculated through Angular Segment Analysis by Metric Distance (ASAMeD), a measure of street integration and choice strongly correlated with pedestrian movement pattern. Street Connectivity was calculated by using the space syntax measure of connectivity, which shows the direct connection of street nodes to each individual nodes. The streets criterion values of both approaches were normalized by using fuzzy logic linear functions. The method was applied in the city center of Qazvin, Iran. Results showed that the urban structure of Qazvin has a strong impact on the performance of the network. The old neighborhood centers widespread in the city center presented a high topological accessibility, while the most connected street are those streets crossing and surrounding the neighborhood areas. The method can be used to evaluate and improve pedestrian networks, as it can distinguish the most and least attractive streets according to the criteria used. These findings can be used to guide policies towards improving walkability and to create more walkable and sustainable cities.

Objective environmental exposures correlate differently with recreational and transportation walking: A cross-sectional national study in the Netherlands

Background Walking is a good and simple way to increase people's energy expenditure, but there is limited evidence whether the neighborhood environment correlates differently with recreational and transportation walking. AimTo investigate how recreational walking and transportation walking are associated with the natural and built environmental characteristics of the living environment in the Netherlands, and examine the differences in their associations between weekdays and weekends. Method and data We extracted the total duration of daily walking (in minutes per person) for recreation and transportation of adults aged 18 years and above from the Dutch National Travel Survey 2015-2017 (N = 65,785) and analyzed it as an outcome variable. Objective measures of the natural (i.e., normalized difference vegetation index (NDVI), blue space and meteorological conditions) and built environment (i.e., crossing density, land-use mix, and residential building density) around respondents' home addresses were determined for buffers with 300, 600, and 1000 m radii using a geographic information system. To assess associations between recreational and transportation walking and the environmental exposures separately, we fitted Tobit regression models to the walking data, adjusted for multiple confounders. ResultsOn weekdays, people living in areas with less NDVI, higher land-use mix, and higher crossing density were more likely to engage in transportation walking. Recreational walking was negatively associated with NDVI, blue space, crossing density, precipitation and daily average temperature. At weekends, land-use mix supports both recreational and transportation walking. A negative association appeared for NDVI and transportation walking. Daily average rainfall and temperature were inversely correlated with recreational walking. Sensitivity tests indicated that some associations depend on the buffer size. ConclusionsOur findings suggest that the built and natural environments are differently associated with people's recreational and transportation walking. We also found differences in the walking-environment associations between weekdays and weekends. Place-based policies to design walking-friendly neighborhoods may have different implications for different types of walking.

Associations between the traditional and novel neighbourhood built environment metrics and weight status among Canadian men and women

OBJECTIVES

Neighbourhood characteristics can impact the health of residents. This study investigated associations between objectively derived neighbourhood characteristics, including novel space syntax metrics, and self-reported body mass index (BMI) among Canadian men and women.

METHODS

Our study included survey data collected from a random cross-section of adults residing in Calgary, Alberta (n = 1718). The survey, conducted in 2007/2008, captured participants' socio-demographic characteristics, health, and weight status (BMI). Participants' household postal codes were geocoded and 1600-m line-based network buffers estimated. Using a geographical information system, we estimated neighbourhood characteristics within each buffer including business destination density, street intersection density, sidewalk length, and population density. Using space syntax, we estimated street integration and walkability (street integration plus population density) within each buffer. Using adjusted regression models, we estimated associations between neighbourhood characteristics and BMI (continuous) and BMI categories (healthy weight vs. overweight including obese). Gender-stratified analysis was also performed.

RESULTS

Business destination density was negatively associated with BMI and the odds of being overweight. Among men, street intersection density and sidewalk length were negatively associated with BMI and street intersection density, business destination density, street integration, and space syntax walkability were negatively associated with odds of being overweight. Among women, business destination density was negatively associated with BMI.

CONCLUSION

Urban planning policies that impact neighbourhood design have the potential to influence weight among adults living in urban Canadian settings. Some characteristics may have a differential association with weight among men and women and should be considered in urban planning and in neighbourhood-focussed public health interventions.

Planning for Supportive Green Spaces in the Winter City of China: Linking Exercise of Elderly Residents and Exercise Prescription for Cardiovascular Health

The elderly population have a high incidence of cardiovascular disease and are the main users of green spaces, such as city parks. Creating supportive green spaces for exercise for the elderly is of great significance to promote their cardiovascular health. The winter cities have a severely cold climate and high incidence of cardiovascular disease, while the elderly, especially those with cardiovascular disease, face more challenges when participating in exercise in the green spaces. In the context of the winter cities, the kinds of exercise the elderly participate in are more conducive to their cardiovascular health, and determining the factors of the green spaces that are supportive for exercise for cardiovascular health in the winter are of particular interest. Taking Harbin, a typical winter city in China, as an example, this study aims to identify the exercise characteristics of elderly residents in the green spaces in winter, to link them with the principles and contents of exercise prescription for cardiovascular health, to identify the deficient factors of the green spaces in supporting exercise for cardiovascular health, and to put forward optimization design implications. Mixed qualitative methods including interviews, a questionnaire, and field observation were used to identify special behavioral characteristics and spatial factors involving winter exercise in the green spaces among the elderly. The results showed that: (1) about 42.4% of the participants had a gap with the principles of exercise prescription for cardiovascular health. Their exercise items were generally consistent with the principle of low-intensity exercise, but some of them had the problems regarding early exercise time and insufficient exercise duration and frequency. (2) Insufficient supportive factors of the green spaces mainly included facilities allocation, comfort, safety, accessibility, and air quality. Facilities allocation involved walking paths, rehabilitation facilities, auxiliary facilities, and guidance facilities; comfort involved sunlight conditions of the exercise areas; safety involved slippery roads and sites with ice and snow and medical accidents; accessibility involved the proximity, the safety of connecting roads, and the movement of the elderly; air quality involved the planting of evergreen trees. Accordingly, the design implications were given in order to bridge the supportive gap of the green spaces for exercise for cardiovascular health in the elderly population.

Does Green Space Really Matter for Residents' Obesity? A New Perspective From Baidu Street View

Despite a growing literature on the topic, the association between neighborhood greenness and body weight is inconsistent. The objective of this research is to examine the association between neighborhood greenness and residents' obesity levels in a high population density area. We accounted for three greenness features: green access, green exposure, and view-based green index. We used the novel technique of deep convolutional neural network architecture to extract eye-level information from Baidu Street View images to capture the urban vertical greenness level. The research involved a survey with 9,524 respondents from 40 communities in Shanghai. Generally, we found all aspects of horizontal greenery, vertical greenery, and proximity of green levels to be impactful on body weight; however, only the view-based green index consistently had an adverse effect on weight and obesity.

Neighbourhood effects on obesity: scoping review of time-varying outcomes and exposures in longitudinal designs

CONTEXT AND OBJECTIVES

Neighbourhood effect research on obesity took off in the early 2000s and was composed of mostly cross-sectional observational studies interested in various characteristics of the built environment and the socioeconomic environment. To limit biases related to self-selection and life course exposures, many researchers apply longitudinal designs in their studies. Until now, no review has specifically and exclusively examined longitudinal studies and the specific designs of these studies. In this review, we intend to answer the following research question: how are the temporal measurements of contextual exposure and obesity outcomes integrated into longitudinal studies that explore how neighbourhood-level built and socioeconomic environments impact adult obesity?

DESIGN

A systematic search strategy was designed to address the research question. The search was performed in Embase, Web of Science and PubMed, targeting scientific papers published before 1 January 2018. The eligible studies reported results on adults, included exposure that was limited to neighbourhood characteristics at the submunicipal level, included an outcome limited to obesity proxies, and reported a design with at least two exposure measurements or two outcome measurements.

RESULTS

This scoping review identified 66 studies that fit the eligibility criteria. A wide variety of neighbourhood characteristics were also measured, making it difficult to draw general conclusions about associations between neighbourhood exposure and obesity. We applied a typology that classified studies by whether exposure and outcome were measured as varying or fixed. Using this typology, we found that 32 studies reported both neighbourhood exposure and obesity outcomes that were varying in time; 28 reported varying outcomes but fixed exposures; and 6 had fixed outcomes and varying exposures.

CONCLUSION

Our typology illustrates the variety of longitudinal designs that were used in the selected studies. In the light of our results, we make recommendations on how to better report longitudinal designs and facilitate comparisons between studies.

Exploring the Relationship between Green Space in a Neighbourhood and Cardiovascular Health in the Winter City of China: A Study Using a Health Survey for Harbin

A severely cold climate has a significant impact on cardiovascular health, involving temperature, air environment, exercise and diet. Existing studies have revealed that green space, as an important health resource, may play a positive role in promoting cardiovascular health through the air environment and exercise. Studies focusing on the correlation between green space and cardiovascular health are rarely carried out in winter cities. The purpose of this paper is to take a winter city in China as an empirical case to explore the correlation between green space in a neighbourhood and cardiovascular health in a representative sample at the neighbourhood level, combining the results with Urban Residential Area Planning and Design Standards (GB50180-2018) in China and the existing research. The results showed that green space characteristics of a neighbourhood were related to cardiovascular disease and some of its risk factors. In neighbourhoods with a Green Space Ratio lower than 28%, residents had a higher risk of physical inactivity, overweight or obesity, hypertension and stroke. In neighbourhoods with a Green View Index lower than 15%, residents had a higher risk of physical inactivity, overweight/obesity, hypertension, dyslipidemia and stroke. A correlation was found between evergreen tree configuration type and the prevalence of overweight/obesity and hypertension. No correlation was found between the type of sports field and cardiovascular disease and its risk factors, except for hypertension. Residents' cardiovascular health scores also showed significant differences among neighbourhoods with different green space characteristics. Intervention efforts may benefit from emphasising the importance of improving the Green Space Ratio and Green View Index effectively in a neighbourhood to reduce the risk of cardiovascular disease.

Neighborhood Walkability in Relation to Knee and Low Back Pain in Older People: A Multilevel Cross-Sectional Study from the JAGES

Few studies have focused on a relationship between the built environment and musculoskeletal pain. This study aimed to investigate an association between neighborhood walkability and knee and low back pain in older people. Data were derived from the Japan Gerontological Evaluation Study (JAGES) 2013, a population-based study of independently living people ≥65 years old. A cross-sectional multilevel analysis was performed, of 22,892 participants in 792 neighborhoods. Neighborhood walkability was assessed by residents' perceptions and population density. Dependent variables were knee and low back pain restricting daily activities within the past year. The prevalence of knee pain was 26.2% and of low back pain 29.3%. After adjusting for sociodemographic covariates, the prevalence ratio (PR) of knee and low back pain was significantly lower in neighborhoods with better access to parks and sidewalks, good access to fresh food stores, and higher population densities. After additionally adjusting for population density, easier walking in neighborhoods without slopes or stairs was significantly inversely correlated with knee pain (PR 0.91, 95% confidence interval 0.85-0.99). Neighborhoods with walkability enhanced by good access to parks and sidewalks and fresh food stores, easy walking without slopes or stairs, and high population densities, had lower prevalences of knee and low back pain among older people. Further studies should examine environmental determinants of pain.

A Systematic Measurement of Street Quality through Multi-Sourced Urban Data: A Human-Oriented Analysis

Many studies have been made on street quality, physical activity and public health. However, most studies so far have focused on only few features, such as street greenery or accessibility. These features fail to capture people's holistic perceptions. The potential of fine grained, multi-sourced urban data creates new research avenues for addressing multi-feature, intangible, human-oriented issues related to the built environment. This study proposes a systematic, multi-factor quantitative approach for measuring street quality with the support of multi-sourced urban data taking Yangpu District in Shanghai as case study. This holistic approach combines typical and new urban data in order to measure street quality with a human-oriented perspective. This composite measure of street quality is based on the well-established 5Ds dimensions: Density, Diversity, Design, Destination accessibility and Distance to transit. They are combined as a collection of new urban data and research techniques, including location-based service (LBS) positioning data, points of interest (PoIs), elements and visual quality of street-view images extraction with supervised machine learning, and accessibility metrics using network science. According to these quantitative measurements from the five aspects, streets were classified into eight feature clusters and three types reflecting the value of street quality using a hierarchical clustering method. The classification was tested with experts. The analytical framework developed through this study contributes to human-oriented urban planning practices to further encourage physical activity and public health.

Built environment and cardio-metabolic health: systematic review and meta-analysis of longitudinal studies

Built environment attributes may be related to cardio-metabolic diseases (e.g. type 2 diabetes, heart disease and stroke) and their risk factors, potentially by influencing residents' physical activity. However, existing literature reviews on the built environment and health for the most part focus on obesity as the outcome and rely on cross-sectional studies. This systematic review synthesized current evidence on longitudinal relationships between built environment attributes and cardio-metabolic health outcomes among adults and on the potential mediating role of physical inactivity. By searching eight databases for peer-reviewed journal articles published in the English language between January 2000 and July 2016, the review identified 36 articles. A meta-analysis method, weighted Z-test, was used to quantify the strength of evidence by incorporating the methodological quality of the studies. We found strong evidence for longitudinal relationships of walkability with obesity, type 2 diabetes and hypertension outcomes in the expected direction. There was strong evidence for the impact of urban sprawl on obesity outcomes. The evidence on potential mediation by physical activity was inconclusive. Further longitudinal studies are warranted to examine which specific built environment attributes influence residents' cardio-metabolic health outcomes and how physical inactivity may be involved in these relationships.

Commuting Mode Choice in a High-Density City: Do Land-Use Density and Diversity Matter in Hong Kong?

Hong Kong is a densely populated and transit-oriented Chinese city, which provides an ideal urban environment with which to study the various successful facets of land use policy as a model for potential replication to curb increasing car use in other Chinese cities. We examine the commuting mode choice of 203,900 households living in 4768 street blocks in Hong Kong from 2011 census. A street block is the smallest planning unit, made up of one or more housing estates with a homogenous built environment and socioeconomic status. The built environment is measured using the five Ds framework, an international dimensioning framework for classifying and measuring attributes of the built environment for physical activity and travel behaviors. Generalized, multi-level mixed models were applied to detect the associations between travel choice and built environment characteristics, while adjusting for socioeconomic status. Design and destination accessibility had greater effects on the choices to walk and take public transport than on the choice to drive. Density and diversity had only marginal effects on mode choice. Unexpectedly, distance to the urban center had the opposite effect on automobile use to that found in Western studies. Hong Kong residents living close to the urban center were more likely to drive for commuting trips. The contrasting findings between our study and Western studies suggest that the associations between a high-density built environment and travel choice vary with urban context.

Neighbourhood walkability and incidence of hypertension: Findings from the study of 429,334 UK Biobank participants

BACKGROUND

With an estimated one billion hypertension cases worldwide, the role of the built environment in its prevention and control is still uncertain. The present study aims to examine the associations between neighbourhood walkability and hypertension in a large and diverse population-based cohort.

MATERIALS AND METHODS

We examined the association between neighbourhood walkability and blood pressure outcomes for N = 429,334 participants drawn from the UK Biobank and aged 38-73 years. Neighbourhood walkability was objectively modelled from detailed building footprint-level data within multi-scale functional neighbourhoods (1.0-, 1.5- and 2.0-kilometer street catchments of geocoded dwelling). A series of linear and modified Poisson regression models were employed to examine the association between walkability and outcomes of diastolic blood pressure (DBP in mmHg), systolic blood pressure (SBP in mmHg) and prevalent hypertension adjusting for socio-demographic, lifestyle and related physical environmental covariates. We also examined the relationship between walkability and change in blood pressure for a sub-sample of participants with follow-up data and tested for interaction effects of age, sex, employment status, neighbourhood SES, residential density and green exposure.

RESULTS

Neighbourhood walkability within one-kilometer street catchment was beneficially associated with all the three blood pressure outcomes, independent of all other factors. Each interquartile increment in walkability was associated with the lower blood pressure outcomes of DBP (β = -0.358, 95% CI: -0.42, -0.29 mmHg), SBP (β = -0.833, 95% CI: -0.95, -0.72 mmHg) as well as reduced hypertension risk (RR = 0.970, 95% CI: 0.96, 0.98). The results remained consistent across spatial and temporal scales and were sensitive to sub-groups, with pronounced protective effects among female participants, those aged between 50 and 60 years, in employment, residing in deprived, high density and greener areas.

CONCLUSION

This large population-based cohort found evidence of protective association between neighbourhood walkability and blood pressure outcomes. Given the enduring public health impact of community design on individual behaviour and lifestyle, of particular interest, are the targetted upstream-level interventions in city design aimed at optimizing walkability. Further long term studies are required to assess its sustained effects upon hypertension prevention and control.

Model-based and design-based inference goals frame how to account for neighborhood clustering in studies of health in overlapping context types

Accounting for non-independence in health research often warrants attention. Particularly, the availability of geographic information systems data has increased the ease with which studies can add measures of the local "neighborhood" even if participant recruitment was through other contexts, such as schools or clinics. We highlight a tension between two perspectives that is often present, but particularly salient when more than one type of potentially health-relevant context is indexed (e.g., both neighborhood and school). On the one hand, a model-based perspective emphasizes the processes producing outcome variation, and observed data are used to make inference about that process. On the other hand, a design-based perspective emphasizes inference to a well-defined finite population, and is commonly invoked by those using complex survey samples or those with responsibility for the health of local residents. These two perspectives have divergent implications when deciding whether clustering must be accounted for analytically and how to select among candidate cluster definitions, though the perspectives are by no means monolithic. There are tensions within each perspective as well as between perspectives. We aim to provide insight into these perspectives and their implications for population health researchers. We focus on the crucial step of deciding which cluster definition or definitions to use at the analysis stage, as this has consequences for all subsequent analytic and interpretational challenges with potentially clustered data.

Association between adiposity outcomes and residential density: a full-data, cross-sectional analysis of 419 562 UK Biobank adult participants

BACKGROUND

Obesity is a major health issue and an important public health target for urban design. However, the evidence for identifying the optimum residential density in relation to obesity has been far from compelling. We examined the association of obesity with residential density in a large and diverse population sample drawn from the UK Biobank to identify healthy-weight-sustaining density environments.

METHODS

For this full-data, cross-sectional analysis, we used UK Biobank data for adult men and women aged 37-73 years from 22 cities across the UK. Baseline examinations were done between 2006 and 2010. Residential unit density was objectively assessed within a 1 km street catchment of a participant's residence. Other activity-influencing built environment factors were measured in terms of density of retail, public transport, and street-level movement density, which were modelled from network analyses of through movement of street links within the defined catchment. We regressed adiposity indicators of body-mass index (BMI; kg/m²), waist circumference (cm), whole body fat (kg), and obesity (WHO criteria of BMI ≥30 kg/m²) on residential density (units per km²), adjusting for activity-influencing built environment factors and individual covariates. We also investigated effect modification by age, sex, employment status, and physical activity. We used a series of linear continuous and logistic regression models and non-linear restricted cubic spline models as appropriate.

FINDINGS

Of 502 649 adults in the prospective cohort, 419 562 (83·5%) participants across 22 UK Biobank assessment centres met baseline data requirements and were included in the analytic sample. The fitted restricted cubic spline adiposity-residential density dose-response curve identified a turning point at a residential density of 1800 residential units per km². Below a residential density of 1800 units per km², an increment of 1000 units per km² was positively related with adiposity, being associated with higher BMI (β 0·19 kg/m², 95% CI 0·14 to 0·24), waist circumference (β 0·41 cm, 0·28 to 0·54), and whole body fat (β 0·40 kg, 0·30 to 0·50), and with increased odds of obesity (odds ratio [OR] 1·10, 1·07 to 1·14). Beyond 1800 units per km², residential density had a protective effect on adiposity and was associated with lower BMI (β -0·22 kg/m², -0·25 to -0·20), waist circumference (β -0·54 cm, -0·61 to -0·48), and whole body fat (β -0·38 kg, -0·43 to -0·33), and with decreased odds of obesity (OR 0·91, 0·90 to 0·93). Subgroup analyses identified more pronounced protective effects of residential density among individuals who were younger, female, in employment, and accumulating higher levels of physical activity, except in the case of whole body fat, for which the protective effects were stronger in men.

INTERPRETATION

Housing-level policy related to the optimisation of healthy density in cities might be a potential upstream-level public health intervention towards the minimisation and offsetting of obesity; however, further research based on accumulated prospective data is necessary for evidencing specific pathways. The findings might mean that governments, such as the UK Government, who are attempting to prevent suburban densification by, for example, prohibiting the subdivision of single lot housing and the conversion of domestic gardens to housing lots, will potentially have the effect of inhibiting the conversion of suburbs into more healthy places to live.

FUNDING

University of Hong Kong, UK Biobank, and UK Economic & Social Research Council.

Residential greenness and adiposity: Findings from the UK Biobank

BACKGROUND

With the rapid urbanization and prevailing obesity pandemic, the role of residential green exposures in obesity prevention has gained renewed focus. The study investigated the effects of residential green exposures on adiposity using a large and diverse population sample drawn from the UK Biobank.

MATERIALS AND METHODS

This was a population based cross-sectional study of 333,183 participants aged 38-73years with individual-level data on residential greenness and built environment exposures. Residential greenness was assessed through 0.50-metre resolution normalized difference vegetation index (NDVI) derived from spectral reflectance measurements in remotely sensed colour infrared data and measured around geocoded participants' dwelling. A series of continuous and binary outcome models examined the associations between residential greenness and markers of adiposity, expressed as body-mass index (BMI) in kg/m², waist circumference (WC) in cm, whole body fat (WBF) in kg and obesity (BMI≥30kg/m²) after adjusting for other activity-influencing built environment and individual-level confounders. Sensitivity analyses involved studying effect modification by gender, age, urbanicity and SES as well as examining relationships between residential greenness and active travel behaviour.

RESULTS

Residential greenness was independently and consistently associated with lower adiposity, the association being robust to adjustments. An interquartile increment in NDVI greenness was associated with lower BMI (β_BMI=-0.123kg/m², 95% CI: -0.14, -0.10kg/m²), WC (β_WC=-0.551cm, 95% CI: -0.61, -0.50cm), and WBF (β_WBF=-0.138kg, 95% CI: -0.18, -0.10kg) as well as a reduced relative risk of obesity (RR=0.968, 95% CI: 0.96, 0.98). Residential greenness was beneficially related with active travel, being associated with higher odds of using active mode for non-work travel (OR=1.093, 95% CI: 1.08, 1.11) as well as doing >30min walking (OR=1.039, 95% CI: 1.03, 1.05).

CONCLUSION

Residing in greener areas was associated with healthy weight outcomes possibly through a physical activity-related mechanism. Green allocation and design may act as upstream-level public health interventions ameliorating the negative health externalities of obesogenic urban environments. Further prospective studies are needed to identify potential causal pathways and thereby effectively guide such interventions.

Geographic variation in the relationship between body mass index and the built environment

Studies examining associations between weight status and neighborhood built environment (BE) have shown inconsistent results and have generally focused on urban settings. However, many Americans do not live in metropolitan areas and BE impacts may be different outside of metropolitan areas. We sought to examine whether the relationship between body mass index (BMI) and neighborhood BE exists and varies by geographic region across small towns in the United States. We conducted telephone surveys with 2156 adults and geographic information systems data in nine towns located within three geographic regions (Northeast, Texas, Washington) in 2011 and 2012. Multiple regression models examined the relationship between individual BMI and BE measures. Most physical activity variables were significantly associated with lower BMI in all geographic regions. We saw variation across geographic region in the relationship between characteristics of the BE variables and BMI. Some perceived and objectively-measured characteristics of the BE were significantly associated with adult BMI, but significant relationships varied by geographic region. For example, in the Northeast, perceived attractiveness of the neighborhood as a reason for why they chose to live there was associated with lower BMI; in Texas, the perceived presence of a fast food restaurant was negatively associated with BMI; in Washington, perceived presence of trees along the streets was associated with lower BMI. Our findings suggest that regional variation plays a role in the relationship between adult BMI and BE characteristics in small towns. Regardless of geographic location, interventions should encourage utilitarian walking and other forms of physical activity.

Policy, Research and Residents' Perspectives on Built Environments Implicated in Heart Disease: A Concept Mapping Approach

An underrepresentation of stakeholder perspectives within urban health research arguably limits our understanding of what is a multi-dimensional and complex relationship between the built environment and health. By engaging a wide range of stakeholders using a participatory concept mapping approach, this study aimed to achieve a more holistic and nuanced understanding of the built environments shaping disease risk, specifically cardiometabolic risk (CMR). Moreover, this study aimed to ascertain the importance and changeability of identified environments through government action. Through the concept mapping process, community members, researchers, government and non-government stakeholders collectively identified eleven clusters encompassing 102 built environmental domains related to CMR, a number of which are underrepresented within the literature. Among the identified built environments, open space, public transportation and pedestrian environments were highlighted as key targets for policy intervention. Whilst there was substantive convergence in stakeholder groups' perspectives concerning the built environment and CMR, there were disparities in the level of importance government stakeholders and community members respectively assigned to pedestrian environments and street connectivity. These findings support the role of participatory methods in strengthening how urban health issues are understood and in affording novel insights into points of action for public health and policy intervention.

A Spatial Analysis of Body Mass Index and Neighborhood Factors in Community-Dwelling Older Men and Women

The spatial distribution of obesity among the older population can yield insights into the influence of contextual factors associated with this public health problem. We tested the relationship between neighborhood-level characteristics and body mass index (BMI) using global and local spatial statistics of geographic clustering, using data derived from a random-digit-dial sample of 5,319 community-dwelling adults aged 50 to 74 residing in 1,313 census tracts in New Jersey. Geographically weighted regression modeled associations between BMI clusters and neighborhood characteristics, including metrics of structure, safety, demographics, and amenities. Across the sample panel, average BMI was 28.62 kg/m(2) for women and 28.25 kg/m(2) for men. There was significant spatial clustering of obesity by census tract, varying by gender across the state. Neighborhood characteristics were more strongly related to BMI for women than men. This research illuminates the role of neighborhood contextual factors and will assist community planners, officials, and public health practitioners as they address the rise in obesity.

Built environment change and change in BMI and waist circumference: Multi-ethnic Study of Atherosclerosis

OBJECTIVE

To examine longitudinal associations of the neighborhood built environment with objectively measured body mass index (BMI) and waist circumference (WC) in a geographically and racial/ethnically diverse group of adults.

METHODS

This study used data from 5,506 adult participants in the Multi-Ethnic Study of Atherosclerosis, aged 45-84 years in 2000 (baseline). BMI and WC were assessed at baseline and four follow-up visits (median follow-up 9.1 years). Time-varying built environment measures (population density, land-use, destinations, bus access, and street characteristics) were created using Geographic Information Systems. Principal components analysis was used to derive composite scores for three built environment factors. Fixed-effects models, tightly controlling for all time-invariant characteristics, estimated associations between change in the built environment, and change in BMI and WC.

RESULTS

Increases in the intensity of development (higher density of walking destinations and population density, and lower percent residential) were associated with less pronounced increases or decreases over time in BMI and WC. Changes in connected retail centers (higher percent retail, higher street connectivity) and public transportation (distance to bus) were not associated with changes in BMI or WC.

CONCLUSIONS

Longitudinal changes in the built environment, particularly increased density, are associated with decreases in BMI and WC.

Is neighbourhood obesogenicity associated with body mass index in women? Application of an obesogenicity index in socioeconomically disadvantaged neighbourhoods

An aggregate index is potentially useful to represent neighbourhood obesogenicity. We created a conceptually-based obesogenicity index and examined its association with body mass index (BMI) among 3786 women (age 18-45y) in socio-economically disadvantaged neighbourhoods in Victoria, Australia. The index included 3 items from each of 3 domains: food resources (supermarkets, green grocers, fast food restaurants), recreational activity resources (gyms, pools, park space), and walkability (4+ leg intersections, neighbourhood walking environment, neighbourhood safety), with a possible range from 0 to 18 reflecting 0-2 for each of the 9 items. Using generalised estimating equations, neighbourhood obesogenicity was not associated with BMI in the overall sample. However, stratified analyses revealed generally positive associations with BMI in urban areas and inverse associations in rural areas (interaction p=0.02). These analyses are a first step towards combining neighbourhood characteristics into an aggregate obesogenicity index that is transparent enough to be adopted elsewhere and to allow examination of the relevance of its specific components in different settings.

Activity-Friendly Built Environment Attributes and Adult Adiposity

Physically-active and sedentary behaviors are determinants of adult weight gain and are associated with built-environment attributes. We reviewed recent evidence on built-environment attributes with adult adiposity. Of 41 relevant papers identified, 34 reported cross-sectional, six recorded prospective findings, and one included both cross-sectional and prospective designs. In 15 cross-sectional examinations of composite built environment indices (walkability; composite other), seven identified significant positive relationships in the expected direction; of 42 instances examining particular walkability elements (density, connectivity, land use mix), 13 were positive. Of 44 instances examining proximity of utilitarian and recreational destinations, there were 13 positive associations; and, of 41 instances examining pedestrian-environment attributes, 12 were positive. In the seven prospective studies, 20 sets of relationships were identified - nine were significant and in the expected direction. Evidence on built environment/adiposity relationships remains modest and could be strengthened through improvements in measurement methods and with further evidence from prospective studies.

Does change in the neighborhood environment prevent obesity in older women?

Neighborhood environment is consistently associated with obesity; changes to modifiable aspects of the neighborhood environment may curb the growth of obesity in the US and other developed nations. However, currently the majority of studies are cross-sectional and thus not appropriate for evaluating causality. The goal of this study was to evaluate the effect of a neighborhood-changing intervention on changes in obesity among older women. Over the past 30 years the Portland, Oregon metropolitan region has made significant investments in plans, regulatory structures, and public facilities to reduce sprawl and increase compact growth centers, transit-oriented development approaches, and green space. We used geocoded residential addresses to link data on land-use mix, public transit access, street connectivity, and access to green space from four time points between 1986 and 2004, with longitudinal data on body mass index (BMI) from a cohort of 2003 community-dwelling women aged 66 years and older. Height and weight were measured at clinic visits. Women self-reported demographics, health habits, and chronic conditions, and self-rated their health. Neighborhood socioeconomic status was assessed from census data. Neighborhood walkability and access to green space improved over the 18-year study period. On average there was a non-significant mean weight loss in the cohort between baseline (mean age 72.6 years) and the study's end (mean age 85.0 years). We observed no association between neighborhood built environment or change in built environment and BMI. Greater neighborhood socioeconomic status at baseline was independently associated with a healthier BMI at baseline, and protected against an age-related decline in BMI over time. BMI decreases with age reflect increased frailty, especially among older adults with complex morbidities. Future research should consider the influence of the neighborhood environment on additional relevant health outcomes and should include measures of the social environment in conjunction with built environment measures.

Urban built environment configuration and psychological distress in older men: results from the Caerphilly study

Background

Few studies have examined the impact of the built environment configuration upon mental health. The study examines the impact of objectively assessed land use and street network configuration upon psychological distress and whether this association is moderated by the natural environment and area-level deprivation.

Methods

In a community sample of 687 older men from the Caerphilly Prospective Study, built environment morphological metrics (morphometrics) were related to differences in psychological distress as measured by the General Health Questionnaire. Cross-sectional data were taken from the most recent (5th) phase. A multi-level analysis with individuals nested within census-defined neighbourhoods was conducted. Environmental measures comprised GIS-constructed land use and street network metrics, slope variability and a satellite derived measure of greenness.

Results

Reduced psychological distress was associated with residing in a terraced dwelling (OR = 0.48, p = 0.03), higher degrees of land-use mix (OR = 0.42, p = 0.03 for the high tertile) and having higher local-level street-network accessibility (‘movement potential’) (OR = 0.54, p = 0.03). Hillier topography with higher slope variability was associated with increased risks of psychological distress (OR = 1.38, p = 0.05).

Conclusions

The findings support our hypothesis that built environment configuration is independently associated with psychological distress. The study underscores the need for effective intervention in the planning and design of residential built environment to achieve the goal of health-sustaining communities.