Would increasing access to recreational places promote healthier weights and a healthier nation?

Residential relocation to assess impact of changes in the living environment on cardio-respiratory health: A narrative literature review with considerations for exposome research

Residential relocation studies have become increasingly valuable tools for evaluating the effects of changing living environments on human health, but little is known about their application to multiple aspects of the living environment and the most appropriate methodology. This narrative review explores the utility of residential relocation as a natural experiment for studying the impact of changing urban exposures on cardio-metabolic health in high-income settings. It provides a comprehensive overview of the use of residential relocation studies, evaluates their methodological approaches, and synthesizes findings related to health behaviors and cardio-metabolic outcomes. Our search identified 43 relevant studies published between January 1995 and February 2023, from eight countries, predominantly the USA, Canada, and Australia. The majority of eligible studies were published between 2012 and 2021 and examined changes in various domains of the living environment, such as walkability, the built and social environments, but rarely combinations of exposures. Included studies displayed heterogeneity in design and outcomes, 25 involving only movers and 18 considering both movers and non-movers. To mitigate the issue of residential self-selection bias, most studies employed a "change-in-change" design and adjusted for baseline covariates but only a fraction of them accounted for time-varying confounding. Relocation causes simultaneous changes in various features of the living environment, which presents an opportunity for exposome research to establish causal relationships, using large datasets with increased statistical power and a wide range of health outcomes, behaviors and biomarkers. Residential relocation is not a random process. Thus, studies focusing on living environment characteristics need to carefully select time-varying covariates and reference group. Overall, this review informs future research by guiding choices in study design, data requirements, and statistical methodologies. Ultimately, it contributes to the advancement of the urban exposome field and enhances our understanding of the complex relationship between urban environments and human health.

Path Analysis to Assess Diversity of Occupational Opportunities Within Walking Distance and Community Health

IMPORTANCE

Built environment structures affect a population's occupational participation and health outcomes.

OBJECTIVE

To examine how occupational opportunities available within walking distance are related to a community's overall health.

DESIGN

Secondary data analysis.

SETTING

Community.

PARTICIPANTS

Community-dwelling adults.

OUTCOMES AND MEASURES

Data from the AARP Livability Index and Walk Score® for 78 zip codes were used for path analysis and multiple regression analysis to investigate the relationship between various community factors and the health of the community.

RESULTS

Path analysis for 78 zip codes revealed that the primary determinants of health score were destination diversity and social walk score. Multiple regression analysis revealed that destination diversity (β < .001) and exercise opportunity (β < .001) were significant factors for health score. Multiple regression analysis revealed that destination diversity (β < .001) was a significant factor for social score.

CONCLUSIONS AND RELEVANCE

The results suggest that increased diversity of destinations in a community and opportunities available for social participation within walking distance are associated with better health of residents in the community. Plain-Language Summary: This study highlights how the built environment and opportunities for social participation are associated with a community's overall health. This study found that participation in a variety of group activities contributes to community members' well-being. Understanding how the built environment is related to health outcomes may better equip occupational therapy practitioners to improve the health of an individual, group, or population.

Investigating where adolescents engage in moderate to vigorous physical activity and sedentary behaviour: An exploratory study

BACKGROUND

There is a persistent lack of understanding on the influence of the environment on behaviour and health. While the environment is considered an important modifiable determinant of health behaviour, past research assessing environments often relies on static, researcher-defined buffers of arbitrary distance. This likely leads to misrepresentation of true environmental exposures. This exploratory study aims to compare researcher-defined and self-drawn buffers in reflecting the spaces and time adolescents engage in physical activity (PA) and sedentary behaviour. It also investigates if adolescent's access the PA facility and greenspace nearest their home or school for PA, as well as examine how much time adolescents spent in PA at any PA facilities and greenspaces.

METHODS

Adolescents (aged 14-18 years; n = 34) were recruited from schools in West Yorkshire, England. Seven consecutive days of global positioning system (GPS) and accelerometer data were collected at 15 second intervals. Using ArcGIS, we compared 30 different researcher-defined buffers including: radial, network and ellipse buffers at 400m, 800m, 1000m, 1600m and 3000m and participant-defined self-drawn neighbourhoods to objectively measured PA and sedentary space and PA time. Location of PA was also compared to Points of Interest data to determine if adolescents use the nearest PA facility or greenspace to their home or school and to examine how much PA was undertaken within these locations.

RESULTS

Our exploratory findings show the inadequacy of researcher-defined buffer size in assessing MVPA space or sedentary space. Furthermore, less than 35% of adolescents used the greenspaces or PA facilities nearest to their home or school. Approximately 50% of time spent in PA did not occur within the home, school, PA facility, or greenspace environments.

CONCLUSION

Our exploratory findings help to begin to quantify the inadequacy of researcher-defined, and self-drawn buffers in capturing adolescent MVPA and sedentary space, as well as time spent in PA. Adolescents often do not use PA facilities and greenspaces nearest their home and school and a large proportion of PA is achieved outside PA facilities and greenspaces. Further research with larger samples are needed to confirm the findings of this exploratory study.

Investigating how researcher-defined buffers and self-drawn neighbourhoods capture adolescent availability to physical activity facilities and greenspaces: An exploratory study

BACKGROUND

Modifying the environment is considered an effective population-level approach for increasing healthy behaviours, but associations remain ambiguous. This exploratory study aims to compare researcher-defined buffers and self-drawn neighbourhoods (SDN) to objectively measured availability of physical activity (PA) facilities and greenspaces in adolescents.

METHODS

Seven consecutive days of GPS data were collected in an adolescent sample of 14-18 year olds (n = 69). Using Points of Interest and greenspace data, availability of PA opportunities within activity spaces were determined. We compared 30 different definitions of researcher-defined neighbourhoods and SDNs to objectively measured availability.

RESULTS

Findings showed low agreement for all researcher-defined buffers in measuring the availability of PA facilities in activity spaces. However, results were less clear for greenspace. SDNs also demonstrate low agreement for capturing availability to the PA environment.

CONCLUSION

This exploratory study highlights the inadequacy of researcher-defined buffers and SDNs to define availability to environmental features.

Types and spatial contexts of neighborhood greenery matter in associations with weight status in women across 28 U.S. communities

Excess body weight is a risk factor for many chronic diseases. Studies have identified neighborhood greenery as supportive of healthy weight. However, few have considered plausible effect pathways for ecosystem services (e.g., heat mitigation, landscape aesthetics, and venues for physical activities) or potential variations by climate. This study examined associations between weight status and neighborhood greenery that capture ecosystem services most relevant to weight status across 28 U.S. communities. Weight status was defined by body mass index (BMI) reported for 6591 women from the U.S. Sister Study cohort. Measures of greenery within street and circular areas at 500 m and 2000 m buffer distances from homes were derived for each participant using 1 m land cover data. Street area was defined as a 25 m-wide zone on both sides of street centerlines multiplied by the buffer distances, and circular area was the area of the circle centered on a home within each of the buffer distances. Measures of street greenery characterized the pedestrian environment to capture physically and visually accessible greenery for shade and aesthetics. Circular greenery was generated for comparison. Greenery types of tree and herbaceous cover were quantified separately, and a combined measure of tree and herbaceous cover (i.e., aggregate greenery) was also included. Mixed models accounting for the clustering at the community level were applied to evaluate the associations between neighborhood greenery and the odds of being overweight or obese (BMI > 25) with adjustment for covariates selected using gradient boosted regression trees. Analyses were stratified by climate zone (arid, continental, and temperate). Tree cover was consistently associated with decreased odds of being overweight or obese. For example, the adjusted odds ratio [AOR] was 0.92, 95% Confidence Interval [CI]: 0.88-0.96, given a 10% increase in street tree cover at the 2000 m buffer across the 28 U.S. communities. These associations held across climate zones, with the lowest AOR in the arid climate (AOR: 0.74, 95% CI: 0.54-1.01). In contrast, associations with herbaceous cover varied by climate zone. For the arid climate, a 10% increase in street herbaceous cover at the 2000 m buffer was associated with lower odds of being overweight or obese (AOR: 0.75, 95% CI: 0.55-1.03), whereas the association was reversed for the temperate climate, the odds increased (AOR: 1.19, 95% CI: 1.05-1.35). Associations between greenery and overweight/obesity varied by type and spatial context of greenery, and climate. Our findings add to a growing body of evidence that greenery design in urban planning can support public health. These findings also justify further defining the mechanism that underlies the observed associations.

Does Compact Built Environment Help to Reduce Obesity? Influence of Population Density on Waist-Hip Ratio in Chinese Cities

This study aimed to identify the non-linear association between population density and obesity in China and to provide empirical evidence for the public health orientated guideline of urban planning. By conducting a longitudinal study with data collected from the China Health and Nutrition Survey (CHNS) between 2004 and 2011, we applied fixed-effect models to assess the non-linear association between the compact built environment and waist–hip ratio (WHR), controlling for sex, age, nationality, education, employment status, marital status, household size, household income, and residents’ attitudes. Our findings reveal that the built environment is one of the key determinants of obesity. The U-shaped influence of population density on WHR was observed. Moreover, influence differs according to sex and weight status. Our findings indicate healthy city planning has the potential to improve the built environment to reduce obesity risk and promote public health.

Putting 'place' in its place: Comparing place-based factors in interurban analyses of life expectancy in the United States

Extant interurban research in life expectancy greatly suffers from an underestimation of the role of place. Place is often conceptualized as a level of geography; this view ignores categorical differences between types of places. In addition, despite advances in theory and research that support their use, many important place-based factors remain under-utilized as control variables. We use multivariate analyses of life expectancy for the top and bottom quartiles of household income by sex in 148 US counties to compare the strengths of seventeen diverse variables. We find that cities' built, natural, and social environments play strong roles in life expectancy disparity among cities; many place-based variables consistently compare in strength to well-known control variables such as race, education, and behaviors. Furthermore, we find that place impacts men and women differently, even within the same income quartile. Indeed, some factors are associated with higher life expectancy in some demographic groups, and lower life expectancy in others. Researchers can protect against omitted variable bias when investigating public health outcomes by using a wider range of control variables. Researchers should also use better measures of place, and consider selecting specific cases to study.