Association of proximity and density of parks and objectively measured physical activity in the United States: A systematic review

Green space in health research: an overview of common indicators of greenness

Human environments influence human health in both positive and negative ways. Green space is considered an environmental exposure that confers benefits to human health and has attracted a high level of interest from researchers, policy makers, and increasingly clinicians. Green space has been associated with a range of health benefits, such as improvements in physical, mental, and social wellbeing. There are different sources, metrics and indicators of green space used in research, all of which measure different aspects of the environment. It is important that readers of green space research understand the terminology used in this field, and what the green space indicators used in the studies represent in the real world. This paper provides an overview of the major definitions of green space and the indicators used to assess exposure for health practitioners, public health researchers, and health policy experts who may be interested in understanding this field more clearly, either in the provision of public health-promoting services or to undertake research.

Association between residential greenness and incident delirium: A prospective cohort study in the UK Biobank

BACKGROUND

Contemporary environmental health investigations have identified green space as an emerging factor with promising prospects for bolstering human well-being. The incidence of delirium increases significantly with age and is fatal. To date, there is no research elucidating the enduring implications of green spaces on the occurrence of delirium. Therefore, we explored the relationship between residential greenness and the incidence of delirium in a large community sample from the UK Biobank.

METHODS

Enrollment of participants spanned from 2006 to 2010. Assessment of residential greenness involved the land coverage percentage of green space within a buffer range of 300 m and 1000 m. The relationship between residential greenness and delirium was assessed using the Cox proportional hazards model. Further, we investigated the potential mediating effects of physical activity, particulate matter (PM) with diameters ≤2.5 (PM2.5), and nitrogen oxides (NOx).

RESULTS

Of 232,678 participants, 3722 participants were diagnosed with delirium during a 13.4-year follow-up period. Compared with participants with green space coverage at a 300 m buffer in the lowest quartile (Q1), those in the highest quartile (Q4) had 15 % (Hazard ratio [HR] = 0.85, 95 % confidence interval [CI]: 0.77, 0.94) lower risk of incident delirium. As for the 1000 m buffer, those in Q4 had a 16 % (HR = 0.84, 95 % CI: 0.76, 0.93) lower risk of incident delirium. The relationship between green space in the 300 m buffer and delirium was mediated partially by physical activity (2.07 %) and PM2.5(49.90 %). Comparable findings were noted for the green space percentage within the 1000 m buffer.

CONCLUSIONS

Our results revealed that long-term exposure to residential greenness was related to a lower risk of delirium. Air pollution and physical activity exerted a significant mediating influence in shaping this association.

Impacts of social deprivation on mortality and protective effects of greenness exposure in Hong Kong, 1999-2018: A spatiotemporal perspective

Addressing health inequality is crucial for fostering healthy city development. However, there is a dearth of literature simultaneously investigating the effects of social deprivation and greenness exposure on mortality risks, as well as how greenness exposure may mitigate the adverse effect of social deprivation on mortality risks from a spatiotemporal perspective. Drawing on socioeconomic, remote sensing, and mortality record data, this study presents spatiotemporal patterns of social deprivation, population weighted greenness exposure, and all-cause and cause-specific mortality in Hong Kong. A Bayesian regression model was applied to investigate the impacts of social deprivation and greenness exposure on mortality and examine how socioeconomic inequalities in mortality may vary across areas with different greenness levels in Hong Kong from 1999 to 2018. We observed a decline in social deprivation (0.67-0.56), and an increase in greenness exposure (0.34-0.41) in Hong Kong during 1999-2018. Areas with high mortality gradually clustered in the Kowloon Peninsula and the northern regions of Hong Kong Island. Adverse impacts of social deprivation on all-cause mortality weakened in recent years (RR from 2009 to 2013: 1.103, 95%CI: 1.051-1.159, RR from 2014 to 2018: 1.041 95%CI: 0.950-1.139), while the protective impacts of greenness exposure consistently strengthened (RR from 1999 to 2003: 0.903, 95%CI: 0.827-0.984, RR from 2014 to 2018: 0.859, 95%CI: 0.763-0.965). Moreover, the adverse effects of social deprivation on mortality risks were found to be higher in areas with lower greenness exposure. These findings provide evidence of associations between social deprivation, greenness exposure, and mortality risks in Hong Kong over the past decades, and highlight the potential of greenness exposure to mitigate health inequalities. Our study provides valuable implications for policymakers to develop a healthy city.

Mapping Lifestyle Interventions for Gestational Diabetes Prevention: A Scoping Review

PURPOSE OF REVIEW

The purpose of this study was to conduct a scoping review to map intervention, sample, and physiologic measurement characteristics of lifestyle interventions for gestational diabetes mellitus (GDM) prevention.

RECENT FINDINGS

A total of 19 studies met selection criteria from 405 articles screened (PubMed, Web of Science). No studies were US-based (47% multi-site), and all were delivered in clinical settings. The most targeted nutrition components were low carbohydrate intake (sugar rich foods/added sugars, low glycemic index), low fat intake (mainly low-fat meat, dairy, and saturated fat), and increased fruits and vegetables. Many studies promoted 150 min/week moderate-intensity physical activity. Only two studies provided supervised physical activity sessions. Dietitians and nurses were the most common implementers. Samples were characterized as adults with obesity (mean age 31 yr, BMI 31 kg/m2). Asian populations were predominantly studied. Four studies used theoretical frameworks (75% of which used Social Cognitive Theory). GDM diagnostic criteria set forth by the American Diabetes Association were the most widely used. Insulin sensitivity was commonly assessed via fasting indices. There was a lack of multi-disciplinary, multi-level, and theory-based lifestyle interventions for reducing GDM risk. Addressing these gaps and prioritizing high-risk populations in the US with measurement of traditional and novel biomarkers will advance the field.

Association of Park Renovation With Park Use in New York City

Importance

Equity-driven citywide park redesign and renovation, such as the Community Parks Initiative (CPI), has the potential to increase park use and opportunities for physical activity in underserved communities.

Objective

To evaluate changes in patterns of park use following park redesign and renovation in low-income New York City (NYC) neighborhoods.

Design, Setting, and Participants

The Physical Activity and Redesigned Community Spaces study was a prospective quality improvement preintervention-postintervention study design with matched control parks. Thirty-three intervention and 21 control neighborhood parks were selected based on specific criteria related to poverty rates, population growth, and population density in park neighborhoods and not having received more than $250 000 in investment in the past 2 decades. Data were collected at baseline (prerenovation) and 2 follow-up points (3 months and 1 year post renovation) between June 5 and December 4 from 2016 to 2022. Participants were individuals observed as users of study parks.

Intervention

The CPI, which involved the redesign and renovation of neighborhood parks by the municipal government of New York City.

Main Outcomes and Measures

Main outcomes encompassed park use and physical activity levels assessed using the well-validated System for Observing Play and Recreation in Communities. Park use was quantified by total number of park users, categorized by age group (≤20 years vs ≥21 years), sex, and physical activity level (sitting or standing vs walking or vigorous activity). Changes in outcomes between groups were compared via the generalized estimation equation.

Results

A total of 28 322 park users were observed across 1458 scans. At baseline, 6343 of 10 633 users (59.7%) were 20 years or younger, 4927 of 10 632 (46.3%) were female and 5705 (53.7%) were male, and 4641 of 10 605 (43.8%) were sitting or standing. Intervention parks showed more net park users compared with control parks from baseline to the final follow-up (difference-in-difference relative rate ratio, 1.69 [95% CI, 1.22-2.35] users/scan; P = .002). The association was driven by a significant increase in adult users at intervention parks and overall decrease in all users at control parks. Park users engaging in sitting or standing at intervention parks increased (difference, 4.68 [95% CI, 1.71-7.62] users/scan; P = .002) and park users engaging in walking or vigorous physical activity at control parks decreased (difference, -7.30 [95% CI, -10.80 to -4.26] users/scan; P < .001) over time.

Conclusions and Relevance

In this quality improvement study, park redesign and renovation were positively associated with park use in low-income neighborhoods. However, park renovations may need to be accompanied by other programmatic strategies to increase physical activity.

Associations between the built environment and physical activity in children, adults and older people: A narrative review of reviews

BACKGROUND

Physical activity is essential for promoting public health, and it is affected by the built environment at population level. Extensive evidence exists on the associations between the built environment and physical activity, but results are inconclusive for different age groups. Therefore, we conducted a narrative review summarizing existing reviews on the associations between the built environment and physical activity for children, adults and older people and synthesized their findings.

METHODS

We followed the PRISMA 2020 review procedure and searched for systematic reviews published between January 2010 and April 2022 in seven databases (Scopus, Web of Science, Medline, PsycINFO, EMBASE, SocIndex and Cochrane Library) using keywords related to the built environment, urban interventions, physical activity and health.

RESULTS

The selection process yielded 29 reviews with moderate to high quality. From these reviews, we identified 21 built environment characteristics, several of which were positively related to physical activity. For example, children and older people's physical activity was positively associated with pedestrian-friendly features and general safety. Furthermore, adults and older people's physical activity was positively related to the availability and accessibility of shops/commercial services and parks/open spaces. Lastly, the walkability index was positively associated with physical activity in every age group.

CONCLUSION

Our findings provide valuable information on creating health-promoting urban environments for practitioners. Further research is needed to understand which characteristics make urban environments age friendly for physical activity. Special attention should be paid to less explored promising characteristics such as street lighting and the quality of green spaces.

How does multiscale greenspace exposure affect human health? Evidence from urban parks in the central city of Beijing

While the health benefits of exposure to urban greenspace have been widely discussed at different spatial scales, the comprehensive health effects of multiscale greenspace exposure are far from understood. There is a lack of quantified evidence when conducting cost-effective greenspace management practices for promoting human health and well-being. This study proposed a conceptual model that links objective and subjective greenspace exposure metrics at different spatial scales with self-rated health of residents. The model attempted to deconstruct and explore the associations between multiscale greenspace exposure and human health, and a cross-sectional study was conducted to examine the model. Taking urban parks in the central city of Beijing as case study area, the objective greenspace exposure metrics at both the site and subdistrict scales were spatial explicitly assessed, and the subjective exposure metrics and self-rated health status of 1017 respondents were obtained through questionnaire survey and spatial positioning. The results of multiple regression analyses and path analyses suggested that greenspace exposure metrics at both site and subdistrict scales were significantly associated with the respondents' self-rated health status, with the exposure metrics at the site scale being more important than those at the subdistrict scale in affecting human health. The contribution of urban parks to self-rated physical and mental health of respondents varied across spatial scales. Specifically, the aesthetic value of urban parks at site scale contributed the most to mental health by promoting respondents' resting behaviors in urban parks, and the density of urban parks at subdistrict scale had the most significant effects on self-rated physical health by increasing the usage frequency of urban parks. Findings of this study can contribute to understanding the complex associations between urban greenspace and human health from a multiscale perspective, and are also expected to provide quantified information for health-oriented urban greenspace planning and management practices.

[Childhood obesity risk index (IROBIC) for small administrative areas in Chile]

Introduction

Introduction: although the prevalence of childhood obesity (CO) is high globally, there are no composite indices to estimate territorial aspects associated with its risk Objective: to develop an obesity risk index (IROBIC) for small administrative units, called "comunas" in Chile Methods: we used 2019 data from public sources on children under 10 years living in "comunas" of the two largest regions. IROBIC includes 16 indicators standardized for each "comuna" and grouped together into four domains, determined by principal component analysis (health, socio-economic, built-in and educational environments). IROBIC was calculated as a weighted geometric mean. Differences in obesity risk between the 10 and 5 "comunas" with the highest and lowest IROBIC and of each domain, were calculated with the disparity ratio. Results: in spite of the poorest "comunas" having the highest IROBIC, when its value and that for each domain were considered, we observed that the effect of inequality could be mitigated. The 10 and 5 "comunas" with the highest IROBIC have a 2.41 and 4.05 higher risk of CO compared to those with the lowest values Conclusions: IROBIC is a useful tool for monitoring the risk of CO and its factors from a territorial perspective.

Cultivating an Active Living Plan Through a Social-Ecological Evaluation

Physical activity (PA) social-ecological model (SEM) posits the importance of several levels of influence critical for PA promotion within communities. The purpose of this study was to examine an SEM evaluation informing a county-wide active living plan in McLennan County, Texas in the United States. Mixed-methods evaluation occurred in 4 stages: (1) county policies (n = 15) were evaluated for PA promoting strategies; (2) PA resource assessments (PARAs) were conducted via Google Maps (n = 171); (3) surveys (n = 244) included the International Physical Activity Questionnaire and interpersonal and intrapersonal factors related to PA; and (4) focus groups (n = 5) were conducted with residents (n = 30), discussing barriers and facilitators to being active. Logistic regression determined significant associations between SEM factors and meeting PA recommendations. Policy scans and PARAs identified strengths and areas of improvement (eg, equitable project selection and disparities in resource quality). Residents reporting fewer barriers (OR = 0.89, P =.01), more perceived behavioral control (odds ratio [OR] = 1.38, P = .01), more social co-participation in PA (OR = 1.20, P = .03), and living in zip codes with higher mean PARA score (OR = 1.22, P = .04) were significantly more likely to meet PA recommendations (Nagelkerke R2 = 0.32). Focus groups also discussed safety and disparities in access and quality. This study suggests the utility of the SEM when evaluating and promoting community PA.

Association between neighborhood availability of physical activity facilities and cognitive performance in older adults

The existing evidence on the contextual influence of the availability of local facilities for physical activity on the cognitive health of elderly residents is sparse. This study examined the association between neighborhood physical activity facilities and cognitive health in older individuals. A cohort study of community-dwelling older adults was performed using baseline data and follow-up data from the Taiwan Biobank. Cognitive health was measured in 32,396 individuals aged 60-70 years using the Mini-Mental State Examination (MMSE) with follow-up information on 8025 participants. The district was used as the proxy for local neighborhood. To determine neighborhood physical activity facilities, school campuses, parks, activity centers, gyms, swimming pools, and stadiums were included. Multilevel linear regression models were applied to examine the associations of neighborhood physical activity facilities with baseline MMSE and MMSE decline during follow-up, with adjustment for individual factors and neighborhood socioeconomic characteristics. Multilevel analyses revealed that there was a neighborhood-level effect on cognitive health among older adults. After adjusting for compositional and neighborhood socioeconomic characteristics, baseline MMSE was higher in individuals living in the middle- (beta = 0.12, p-value = 0.140) and high-density facility (beta = 0.22, p-value = 0.025) groups than in the low-density group (p-value for trend-test = 0.031). MMSE decline during follow-up was slower in the middle- (beta = 0.15, p-value = 0.114) and high-density facility (beta = 0.27, p-value = 0.052) groups than in the low-density group (p-value for trend-test = 0.032). Greater neighborhood availability of physical activity facilities was associated with better cognitive health among older residents. These findings have implications for designing communities and developing strategies to support cognitive health of an aging population.

Park Area and Physical Activity Among Children and Adolescents: Findings From the Healthy Communities Study

BACKGROUND

There is currently a nationwide effort to bring parks and green spaces within a 10-minute walk of the home. We examined the association between park area within 1 km of a child's residence and self-reported park-specific physical activity (PA) along with accelerometer-derived moderate to vigorous physical activity (MVPA).

METHODS

A subsample of K through eighth-grade youth (n = 493) from the Healthy Communities Study reported whether they engaged in park-specific PA during the last 24 hours and wore an accelerometer for up to 7 days. Park area was defined as the percentage of park land in a 1 km Euclidean buffer around the participant's residence, categorized into quintiles. Analysis consisted of logistic and linear regression modeling with interaction effects that controlled for clustering within communities.

RESULTS

Regression models estimated greater park-specific PA for participants in the fourth and fifth quintiles of park land. Age, sex, race ethnicity, and family income were unrelated to park-specific PA. Accelerometer analysis indicated that total MVPA was unrelated to park area. Older children (β = -8.73, P < .001) and girls (β = -13.44, P < .001) engaged in less MVPA. Seasonality significantly predicted both park-specific PA and total MVPA.

CONCLUSION

Increasing park area is likely to improve youth PA patterns, lending support for the 10-minute walk initiative.

Who benefits from green spaces? Surrounding greenness and incidence of cardiovascular disease in a population-based electronic medical records cohort in Madrid

The objective was to study the association between surrounding greenness and the incidence of cardiovascular diseases (CVD) with a four years follow-up in almost half a million high CVD-risk women and men, as well as its differential effect by area-level deprivation in Madrid. We analyzed 2015-2018 primary healthcare electronic medical records for 437,513 high CVD risk individuals representing more than 95% of the population of that age range residing in Madrid. The outcome variable was any cardiovascular event. We measured surrounding residence greenness at 200 m, 300 m, 500 m, and 1000 m through the Normalized Difference Vegetation Index (NDVI). We assessed socioeconomic deprivation through a census-based deprivation index. We estimated the 4-year relative risk of CVD by an increase in 0.1 units of NDVI and then stratified the models by quintiles of deprivation (Q5 the most deprived). We found that for every increase in 0.1 units of NDVI at 1000 m there was a 16% decrease in CVD risk (RR = 0.84 95% CI 0.75-0.94). CVD risk for the remaining distance exposures (at 200 m, 300 m, and 500 m) were none statistically significant. In general, the protective effect of green spaces was present in medium-deprivation areas and males, but the associations were inconsistent across deprivation levels. This study highlights the relevance of evaluating the interaction between physical and social urban components to further understand possible population prevention approaches for cardiovascular diseases. Future studies should focus on the mechanisms of context-specific interactions between social inequalities and green spaces' effects on health.

Visiting nature is associated with lower socioeconomic inequalities in well-being in Wales

Natural environments can promote well-being through multiple mechanisms. Many studies have investigated relationships between residential green/blue space (GBS) and well-being, fewer explore relationships with actual use of GBS. We used a nationally representative survey, the National Survey for Wales, anonymously linked with spatial GBS data to investigate associations of well-being with both residential GBS and time in nature (N = 7631). Both residential GBS and time spent in nature were associated with subjective well-being. Higher green-ness was associated with lower well-being, counter to hypotheses (predicting the Warwick and Edinburgh Mental Well-Being Scale (WEMWBS): Enhanced vegetation index β =  - 1.84, 95% confidence interval (CI) - 3.63, - 0.05) but time spent in nature was associated with higher well-being (four hours a week in nature vs. none β = 3.57, 95% CI 3.02, 4.13). There was no clear association between nearest GBS proximity and well-being. In support of the equigenesis theory, time spent in nature was associated with smaller socioeconomic inequalities in well-being. The difference in WEMWBS (possible range 14-70) between those who did and did not live in material deprivation was 7.7 points for those spending no time in nature, and less at 4.5 points for those spending time in nature up to 1 h per week. Facilitating access and making it easier for people to spend time in nature may be one way to reduce socioeconomic inequalities in well-being.

Built Environment Accessibility and Disability as Predictors of Well-Being among Older Adults: A Norwegian Cross-Sectional Study

Knowledge about the influence environmental factors have on well-being is important to deliver policies supporting healthy ageing and sustainable health equity. An under-researched question is whether and how the built environment plays a role on well-being among older adults with disabilities. This study explores the relationship between built environment accessibility and disability on psychosocial well-being among older adults. Data were used from the Norwegian Counties Public Health Survey collected during February 2021 in Møre and Romsdal county (N = 8274; age = 60-97, mean = 68.6). General linear modelling was performed to examine the relationship and interaction between built environment accessibility (services, transportation, and nature) and disability on psychosocial well-being (quality of life, thriving, loneliness, and psychological distress). Higher levels of disability and poorer accessibility were each significantly related to lower psychosocial well-being across all variables (p < 0.001). Significant interaction effects were observed between disability and built environment accessibility on thriving (F(8, 5936) = 4.97, p < 0.001, η² = 0.006) and psychological distress (F(8, 5957) = 3.09, p = 0.002, η² = 0.004). No significant interaction effects were found for quality of life and loneliness. These findings indicate good built environment accessibility is associated with thriving and reduces psychological distress among older adults with disabilities. This study supports and extends previous findings on the importance of accessible and equipped environments for well-being and may aid policy makers when planning built environments to foster healthy ageing among this population group.

Examining activity-friendly neighborhoods in the Norwegian context: green space and walkability in relation to physical activity and the moderating role of perceived safety

BACKGROUND

Despite the well-known health benefits of regular physical activity, inactivity remains a major public health concern. Understanding how the built environment can encourage physical activity is therefore important to inform current policy strategies for creating activity-friendly neighborhoods. This study aimed to examine whether neighborhood walkability and greenness were associated with physical activity, and if perceived safety moderated any such relations, among adult citizens in Norway.

METHODS

This cross-sectional study included a sample of 5670 adults aged ≥ 18 years living in urban areas of Stavanger. Information on physical activity (PA) levels, perceived neighborhood safety, and socio-demography were obtained from questionnaire data collected in the Norwegian county public health survey of Rogaland. Geographic information systems were utilized to compute walkability, vegetation scores and proportion of green space within postcode areas, which subsequently were linked to the survey data. Hierarchical linear regression models were fitted to examine associations between walkability, amount of vegetation, proportion of green space and weekly minutes of PA, and to estimate main and interaction effects of perceived safety on these relationships.

RESULTS

The adults were on average physically active 148.3 min/week. The amount of green vegetation in the neighborhood was positively related to physical activity when adjusting for potential confounders. No such relations were observed for proportion of green space and walkability. Perceived neighborhood safety was significantly related to increased levels of physical activity, but no moderating role of perceived safety was observed.

CONCLUSION

Although our findings should be interpreted with caution, the results point towards the importance of policymakers, planners, and public health professionals to advocate for safe environments with green vegetation for physical activity in the neighborhood.

Beyond Proximity: Utility-Based Access from Location-Based Services Data

Understanding who in a community has access to its resources-parks, libraries, grocery stores, etc.-has profound equity implications, but typical methods to understand access to these resources are limited. Travel time buffers require researchers to assert mode of access as well as an arbitrary distance threshold; further, these methods do not distinguish between destination quality attributes in an effective way. In this research, we present a methodology to develop utility-based accessibility measures for parks, libraries, and grocery stores in Utah County, Utah. The method relies on passive location-based services data to model destination choice to these community resources; the destination choice model utility functions in turn allow us to develop a picture of regional access that is sensitive to: the quality and size of the destination resource; continuous (non-binary) travel impedance by multiple modes; and the sociodemographic attributes of the traveler. We then use this measure to explore equity in access to the specified community resources across income level in Utah County: the results reveal a discrepancy between which neighborhoods might be targeted for intervention using space-based analysis.

Assessing Park Quality with a Wearable Video Device and an Unmanned Aerial System

Parks are ideal places for promoting physical activity, which is vital for achieving and sustaining good health. Thus, it is important to develop and provide the best methods for assessing aspects of parks that could influence physical activity. This study examined the use of high-tech video capture for describing park quality. Videos were obtained with a wearable video device (WVD) and an unmanned aerial system (UAS) at 28 and 17 parks, respectively. In-person audits of park attributes were performed using the Physical Activity Readiness Assessment (PARA) instrument while video was simultaneously captured. The PARA provides quality ratings of park attributes that range from poor to good. Kappa statistics were calculated to compare in-person PARA outcomes with PARA outcomes obtained by reviewing the WVD and UAS videos. Substantial and almost-perfect agreements were found between WVD and in-person PARAs on the quality of features and amenities and the severity of incivilities. Agreements between UAS and in-person PARAs on feature and amenity quality and incivility severity were unacceptable (mostly fair and moderate). In conclusion, being able to reliably assess park quality using video provides advantages over in-person assessments (e.g., retrospective analysis). In addition, it sets up the possibility of utilizing computer vision to automate the video analysis process.

Exposure to Public Open Spaces and Leisure-Time Physical Activity: An Analysis of Adults in Primary Health Care in Brazil

Public open spaces (POS) enable many leisure activities. However, few studies have evaluated how different exposures to POS with structured physical activities (PA) could affect the leisure-time PA (LTPA) of adults with chronic diseases. This study aimed to analyze the associations between different exposures to POS and LTPA in adults in primary health care in Brazil. In 2019, a cross-sectional study was conducted with a representative sample of 615 users of 15 Basic Health Units in São José dos Pinhais. The POS exposure was measured by the presence and distance (GIS), and the usage and frequency of usage were self-reported. The IPAQ identified walking and moderate-to-vigorous PA (MVPA). Data were analyzed with multilevel Poisson regression adjusted for the possible confounders (sex, age, economic level, chronic diseases). The prevalence of walking and MVPA ≥150 min/week was 12% and 14%, respectively. The usage of POS increased by 52% the likelihood of walking ≥10 min/week (PR: 1.52; 95%CI: 1.02–2.21), while usage ≥2 times/week increased by 2 times the likelihood of this outcome (PR: 2.01; 95%CI: 1.28–3.05). The usage of POS increased by 2.7 times the likelihood of MVPA ≥10 min/week (PR: 2.73; 95%CI: 1.86–3.97), and usage ≥2 times/week increased by 3.5 times the likelihood of this outcome (PR: 3.45; 95%CI: 2.14–5.42). Finally, the usage of POS increased by 3 times the likelihood of MVPA ≥150 min/week (PR: 3.03; 95%CI: 1.92–4.74), while usage ≥2 times/week increased by 3.8 times the likelihood of this outcome (PR: 3.81; 95%CI: 2.19–6.38). In conclusion, only the usage of POS is positively associated with walking and MVPA in the leisure time of adult primary health care users.

Mental health and well-being in times of COVID-19: A mixed-methods study of the role of neighborhood parks, outdoor spaces, and nature among US older adults

The role of parks and nature to support well-being during the COVID-19 pandemic is uncertain. To examine this topic, we used mixed-methods data collected in April-May 2020 from US adults aged ≥55 in the COVID-19 Coping Study. We quantitatively evaluated the associations between number of neighborhood parks and depression, anxiety, and loneliness; and conducted qualitative thematic analysis of participants' outdoor experiences. Among urban residents, depression and anxiety were inversely associated with the number of neighborhood parks. Thematic analysis identified diverse engagement in greenspaces that boosted physical, mental, and social well-being. The therapeutic potential of outdoor and greenspaces should be considered for interventions during future epidemics.

The association between workplace built environment and metabolic health: A systematic review and meta-analysis

BACKGROUND

Metabolic health is one of the key determinants of healthy living. Specifically, maintaining healthy weight, regulation of blood pressure, lipids and glucose over the life course have been reported to be protective on chronic diseases and premature mortality. With the global workforce spending, on average, one-third of the weekly time budget in the workplace, the role of workplace environment in enhancing metabolic health becomes important. However, there has thus far been no review synthesizing evidence on the links between workplace built environment and metabolic health.

METHODS

A systematic review and meta-analysis was conducted synthesizing evidence on the associations of built environment attributes measured within the workplace neighbourhood and metabolic health. A total of 16 studies that fulfilled the inclusion/exclusion criteria were identified via systematic search of English language peer-refereed publications up to July 2021, in six databases. A systematic coding system was developed, indicating significant findings in expected/unexpected directions including null findings, and the quality of the pooled study was assessed. The Weighted-Z test method that accounts for the study quality was used to examine the strength of evidence.

RESULTS

A quarter of the pooled studies were categorized to be of high quality. Among the workplace built environment attributes of access to/density of recreational facilities, street pattern, access to/density of destinations and services, and land use mix, very strong evidence was found for the association between access to/density of destinations and services and metabolic health (p < 0.001); specifically, access to full service establishments such as supermarkets, grocery stores and restaurants (p = 0.001). A relatively weak association between proximity to workplace and metabolic health (p = 0.019) was also reported.

DISCUSSION

Given the lack of high quality studies, overall confidence in the currently available evidence is 'low'. Well-designed longitudinal studies with rigorous measurements for exposures and outcome variables are necessary.

Examining the state, quality and strength of the evidence in the research on built environments and physical activity among children and youth: An overview of reviews from high income countries

BACKGROUND

Built environments have shown to be associated with health, with physical activity (PA) considered one of the critical pathways for achieving benefits. Navigating available evidence on the built environment and PA is challenging given the number of reviews.

OBJECTIVE

Examine the current state and quality of research looking at associations between built environments and total PA and domains of PA (i.e., leisure/recreation, transportation, school) among children and youth (1-18 years).

METHODS

We systematically searched the grey literature and six bibliographic databases from January 2000 to May 2020. Review quality was assessed using the AMSTAR2. Results by age group were synthesized using narrative syntheses and harvest plots, and certainty of the evidence was assessed using a modified GRADE approach.

RESULTS

This overview included 65 reviews. Most reviews were of very low-to-low quality. High certainty was found for positive associations between transportation PA and walking/cycling/active transportation (AT) infrastructure. There was high certainty for positive associations between streets/play streets and total PA, alongside lower certainty for transportation and leisure PA. Very low-to-moderate certainty supports schoolyards designed to promote PA were positively associated with total PA, but mixed for school PA (except children). Less consistent positive associations were found for forests/trees, greenspace/open space, recreation facilities, street lighting, traffic safety, population/residential density, proximity/access to destinations, neighbourhood characteristics, and home environments. There is very low-to-moderate certainty for negative associations between greater distance to school and traffic volume and domains of PA. Generally, null or mixed associations were observed for aesthetics, parks, AT comfort infrastructure, land-use mix, street connectivity, urban/rural status, and public transit.

DISCUSSION

There remains a need for high quality systematic reviews and studies to evaluate the effects of environmental changes across the pediatric age spectrum and using a PA domain approach. Given the global physical inactivity crisis the built environment remains and important means to promote PA among children/youth.

Older people and nature: the benefits of outdoors, parks and nature in light of COVID-19 and beyond- where to from here?

The COVID-19 pandemic has taken a significant toll on people's health and wellbeing globally. In the pandemic, parks, gardens and other local green spaces have been recognised as vital to people's physical and mental health. Emerging global evidence shows increased access to local parks and recreational activities and a new appreciation of the natural surroundings. Various movements and organisations globally have called for actions to embrace recent trends and changes in relation to the planning of public spaces and urban built environments to enable better access to parks and nature. The crisis, however, has exposed the inequities around access to green space where vulnerable populations such as older people and those in low socioeconomic areas are particularly affected. The crisis presents an opportunity to positively impact on society, and an opportunity to consolidate new emerging trends to better integrate nature into the architecture, infrastructure, and public spaces of urban areas.

Associations of public open space attributes with active and sedentary behaviors in dense urban areas: A systematic review of observational studies

In the context of rapid urbanization, public open spaces in dense urban areas are critical built environment elements to support active lifestyles. Several reviews have explored the associations of public open space attributes with physically active and sedentary behavior. However, few reviews have included studies from Asia, and no studies have focused on dense urban areas. This systematic review analyzed 18 observational studies investigating associations between public open space attributes with physical activity and sedentary behavior in dense urban areas of East Asian countries, including Japan, Taiwan, China, and Hong Kong. We found that closer distance to and a greater number of public open spaces and features within them were positively associated with leisure-time physical activity. Places near water features and corridors within public open spaces were associated with more sedentary behavior. These findings inform landscape and urban design guidelines for (re)designing public open spaces to support active lifestyles in high dense urban areas.

Associations of park features with park use and park-based physical activity in an urban environment in Asia: A cross-sectional study

Park use is associated with health, yet our understanding of park features related to their use is limited. Singapore's parks were audited for 30 micro-features, then geospatial analysis characterized micro-features scores for parks nearest to participants' homes. Adults (3,435) reported their park use and park-based physical activity. Using linear regression models, we found living near a park with higher micro-features scores was associated with more time in parks and park-based physical activity. Specific micro-features were associated with more park time (wildlife areas, water features, forested areas, unpaved trails (2-2.6 h/month, p < 0.05)) and with physical activity in parks (water features, forested areas, large playground, open green spaces (1.8-2.2 h/month, p < 0.05)). These findings could inform parks planning to support population-health.

Park access and mental health among parents and children during the COVID-19 pandemic

BACKGROUND

Time spent outdoors and in nature has been associated with numerous benefits to health and well-being. We examined relationships between park access and mental health for children and parents during the COVID-19 pandemic. We also explored associations between park access and co-participation of parent and child in time outdoors, and child and parent physical activity.

METHODS

We used data from 1,000 respondents to a nationally representative U.S. survey of parent-child dyads during October-November 2020. Park access was defined as an affirmative response to: "do you have a park that you can safely walk to within 10 min of your home?" Child mental health was operationalized as the Strengths and Difficulties Questionnaire (SDQ) total difficulties score. The Patient Health Questionnaire-4 (PHQ-4) total score assessed parent mental health and the International Physical Activity Questionnaire (IPAQ) assessed parent physical activity. Child physical activity and co-participation in outdoor activity were reported as number of days in the prior week. Linear regression was used to examine relationships between park access and health outcomes in models adjusted for child and parent characteristics and COVID-19 impact.

RESULTS

Our sample included 500 parents of children ages 6-10 years, and 500 parent-child dyads of children ages 11-17 years. Park access was associated with a lower SDQ total score among children (β: -1.26, 95% CI: -2.25, -0.27) and a lower PHQ-4 total score among parents (β: -0.89, 95% CI: -1.39, -0.40). In models stratified by child age, these associations were observed for SDQ scores among adolescents ages 11-17 and for PHQ-4 scores among parents of children ages 6-10 years. Park access was also associated with 0.50 more days/week of co-participation in outdoor time (95% CI: 0.16, 0.84), and higher levels of parent physical activity (β: 1009 MET-min/week, 95% CI: 301, 1717), but not child physical activity (β: 0.31 days/week, 95% CI: -0.03, 0.66).

CONCLUSIONS

Park access was associated with better mental health among children and parents, and more parent physical activity and parent-child co-participation in outdooractivity during the COVID-19 pandemic. Access to nearby parks may be an important resource to promote health and well-being, for both individuals and families.

Investigating the association between regeneration of urban blue spaces and risk of incident chronic health conditions stratified by neighbourhood deprivation: A population-based retrospective study, 2000-2018

Chronic non-communicable diseases are leading causes of poor health and mortality worldwide, disproportionately affecting people in highly deprived areas. We undertook a population-based, retrospective study of 137,032 residents in Glasgow, Scotland, to investigate the association between proximity to urban blue spaces and incident chronic health conditions during a canal regeneration programme. Hazard ratios (HRs) were estimated using Cox proportional hazards models adjusted for age and sex, with the incidence of a given health condition as the dependent variable. The analyses were stratified by socioeconomic deprivation tertiles. We found that, in areas in the highest deprivation tertile, proximity to blue space was associated with a lower risk of incident cardiovascular disease (HR 0.85, 95% Confidence Interval (CI) 0.76-0.95), hypertension (HR 0.85, 95% CI 0.79-0.92), diabetes (HR 0.88, 95% CI 0.83-0.94), stroke (HR 0.85, 95% CI 0.77-0.94) and obesity (HR 0.90, 95% CI 0.86-0.94), but not chronic pulmonary disease, after adjusting for age and sex covariates. In middle and low deprivation tertiles, living closer to the canal was associated with a higher risk of incident chronic pulmonary disease (middle: HR 1.56, 95% CI 1.24-1.97, low: HR 1.34, 95% CI 1.05-1.73). Moreover, in the middle deprivation tertile, a higher risk of stroke (HR 1.36, 95% CI 1.02-1.81) and obesity (HR 1.14, 95% CI 1.01-1.29) was observed. We conclude that exposure to blue infrastructure could be leveraged to mitigate some of the health inequalities in cities.

Residential greenness-related DNA methylation changes

BACKGROUND

Residential greenness has been associated with health benefits, but its biological mechanism is largely unknown. Investigation of greenness-related DNA methylation profiles can contribute to mechanistic understanding of the health benefits of residential greenness.

OBJECTIVE

To identify DNA methylation profiles associated with greenness in the immediate surroundings of the residence.

METHODS

We analyzed genome-wide DNA methylation in 1938 blood samples (982 participants) from the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA). We estimated residential greenness based on normalized difference vegetation index at 30 × 30 m cell (green30) and 500 m buffer (green500) around the residential address. We conducted epigenome-wide association study (EWAS) to identify differentially methylated CpGs and regions, and enrichment tests by comparing to the CpGs that previous EWAS identified as associated with allergy, physical activity, and allostatic load-relevant biomarkers.

RESULTS

We identified no genome-wide significant CpGs, but 163 and 56 differentially methylated regions for green30 and green500, respectively. Green30-related DNA methylation profiles showed enrichments in allergy, physical activity, and allostatic load, while green500-related methylation was enriched in allergy and allostatic load.

CONCLUSIONS

Residential greenness may have health impacts through allergic sensitization, stress coping, or behavioral changes. Exposure to more proximal greenness may be more health-relevant.

Neighborhood built environment associated with cognition and dementia risk among older adults: A systematic literature review

Cognitive impairment associated with aging is a serious and growing public health problem. This systematic literature review contributes to better understanding the current state of knowledge on the roles of neighborhood environments in supporting cognitive health in later life. Literature search was carried out in 2020 using the seven databases most relevant to the topic. This review was restricted to peer-reviewed observational and quantitative studies that focused on 1) community-dwelling older adults as target populations; 2) neighborhood built environments as independent variables; and 3) cognition or dementia as outcome variables. Thirty-seven studies published between 1989 and 2020 met the inclusion criteria. The neighborhood built environment domains covered in these included urbanity/rurality, land use, neighborhood physical disorder, transportation infrastructure, urban design, and urban nature. Neighborhood resources and green space exposure were most frequently studied and linked to cognition-related outcomes. Neighborhood built environment was shown to be more pertinent to older adults' global cognition, memory, and dementia. Physical activity showed a mediating role between neighborhood built environment and cognition. The effect of neighborhood built environment on cognitive function was stronger among older women and those with disabilities or lower socioeconomic status. Evidence on the relationship between neighborhood built environment and cognition/dementia among older adults is moderate. Our findings highlight the need for more standardized and longitudinal measures of neighborhood built environment and high-sensitivity cognitive tests that capture the specific and relevant domains of cognition, to facilitate further exploration of the mediating and moderating effects of neighborhood built environment with cognition/dementia in older adults. This review offers insights for future research and policy efforts toward creating communities to support cognitive health and aging in place.

Longitudinal Associations Between Neighborhood Park and Open Space Access and Children's Accelerometer-Assessed Measured Physical Activity: The Evidence From the MATCH Study

BACKGROUND

Cross-sectional studies have shown positive associations between neighborhood park access and children's physical activity (PA); however, research that examines the relationship longitudinally is lacking. This study investigates how neighborhood park access affects the longitudinal trajectory of PA in 192 children across 3 years.

METHODS

Accelerometer-assessed PA data of children (N = 202) were collected across 6 semi-annual waves (7 d each) between 2014 and 2018. Geographical information systems was used to measure neighborhood park access (ie, coverage, density, and proximity) at baseline. Mixed-effects models examined the associations of park access with children's baseline and trajectory of moderate to vigorous PA (MVPA) minutes across 3 years and whether the associations differed by sex or weekends versus weekdays.

RESULTS

Higher neighborhood park density, coverage, and proximity were positively associated with children's baseline MVPA minutes per day. Longitudinally, higher park coverage was associated with smaller decreases in children's MVPA minutes per day, but only during weekends. Park density and proximity were not associated with change in MVPA minutes per day. The above associations did not differ by sex.

CONCLUSIONS

Having access to more neighborhood parklands protected against age-related declines in children's PA. These findings suggest that neighborhood park coverage should be considered by urban planners when evaluating the health impacts of their policies.

Does the built environment have independent obesogenic power? Urban form and trajectories of weight gain

OBJECTIVE

To determine whether selected features of the built environment can predict weight gain in a large longitudinal cohort of adults.

METHODS

Weight trajectories over a 5-year period were obtained from electronic health records for 115,260 insured patients aged 18-64 years in the Kaiser Permanente Washington health care system. Home addresses were geocoded using ArcGIS. Built environment variables were population, residential unit, and road intersection densities captured using Euclidean-based SmartMaps at 800-m buffers. Counts of area supermarkets and fast food restaurants were obtained using network-based SmartMaps at 1600, and 5000-m buffers. Property values were a measure of socioeconomic status. Linear mixed effects models tested whether built environment variables at baseline were associated with long-term weight gain, adjusting for sex, age, race/ethnicity, Medicaid insurance, body weight, and residential property values.

RESULTS

Built environment variables at baseline were associated with differences in baseline obesity prevalence and body mass index but had limited impact on weight trajectories. Mean weight gain for the full cohort was 0.06 kg at 1 year (95% CI: 0.03, 0.10); 0.64 kg at 3 years (95% CI: 0.59, 0.68), and 0.95 kg at 5 years (95% CI: 0.90, 1.00). In adjusted regression models, the top tertile of density metrics and frequency counts were associated with lower weight gain at 5-years follow-up compared to the bottom tertiles, though the mean differences in weight change for each follow-up year (1, 3, and 5) did not exceed 0.5 kg.

CONCLUSIONS

Built environment variables that were associated with higher obesity prevalence at baseline had limited independent obesogenic power with respect to weight gain over time. Residential unit density had the strongest negative association with weight gain. Future work on the influence of built environment variables on health should also examine social context, including residential segregation and residential mobility.

Neighborhood Built Environment Impacts Park Use of Diverse, Low-Income Mothers With Their Children

Built environment features, including parks, often exacerbate health disparities. We examined built environment perceptions and park use among a population at high risk for negative physical health outcomes: racially diverse, low-income mothers across the United States. Perceived safety from crime and living near a park were associated with more frequent park use for mothers with their children, and neighborhood walkability was linked to longer park visits. However, only 40% of mothers lived within a 10-minute walk of a park, and overall perceptions of walkability and safety from crime were low. To enhance physical activity and health of low-income mothers with their children, investments are needed to close disparities in park access and improve neighborhood safety.

Active use and perceptions of parks as urban assets for physical activity: A mixed-methods study

Parks are potential key urban assets for improved population health; however, their use is not equal among all social groups. Individual and contextual factors could influence residents' perceptions of parks and how they interact with and, eventually, benefit from them. The use of complementary methodologies provides a deeper understanding of the relationship between park use, physical activity (PA), and residents' perceptions. Thus, we designed a mixed-methods study to analyze differences in park use and PA, and the perceptions of parks as urban assets for PA. We selected six parks from three neighborhoods in Madrid (Spain) with different neighborhood socioeconomic status (NSES) for systematic social observation. We registered park users by age, PA level (low, medium, and high), gender, and NSES using the System for Observing Play and Recreation in Communities (SOPARC) audit tool adapted for iOS software (iSOPARC). We also conducted 37 semi-structured interviews and 29 focus groups to analyze residents' perceptions of parks as urban assets for PA in the same neighborhoods. We adopted a convergent-parallel design to analyze both quantitative and qualitative data, and to describe the convergence and divergence areas between them. Parks within the high-NSES were more visited, showing a higher proportion of people performing high PA (11.9%) as compared to residents of the middle (9.3%) and low-NSES (3.2%). Female visitors showed lower PA levels compared to men, especially for parks within high-NSES. The following issues were reported as influence urban park use and perceptions: park maintenance and area perception, works constraints, insecurity and crime, differential perceptions by age, and the availability of organized activities in the parks. Residents from high-NSES reported fewer barriers to park use compared to residents from the other areas, who reported limitations such as less leisure time due to job constrains or perceived insecurity in parks. Senior participants reported that having parks with organized activities and a design oriented towards different age-groups are valuable. Our study shows consistency between the fewer and less intense use of parks registered in the middle and low-NSES neighborhoods, and the more barriers for PA reported in this areas during the qualitative analysis. Mixed-methods provided an insight of the potential causes leading to the differences in park use and PA within cities, which is essential in terms of environmental justice and health equity. Thus, a mixed-methods comprehensive approach to public health problems can help designing public policies addressing relevant factors related to urban health inequities.

Where do the children play? An objective analysis of children's use of green space

Green space is important for health, yet, objective research on children's use of green space is sparse. This study aimed to objectively assess children's use of green space in both public and private settings during their summer leisure time, using wearable cameras. Images from cameras worn by 74 children were analysed for green space use over 4 days. Children spent an average of ∼1/10 h of leisure time in green space in the summer months, were physically active 68%, and with others 85%, of the time. Green spaces are important places for children's health because they are places they frequent and places where they are physically active and socialize. Wearable cameras provide an effective method for objective assessment of green space use.

Effects of Evocative Audio-Visual Installations on the Restorativeness in Urban Parks

Road traffic noise is responsible for several negative health effects for citizens in modern cities. Inside urban parks, which citizens use for social inclusion and cohesion, psychological and physical restoration, and physical activities, road traffic noise may significantly reduce the potential of these places to induce or enhance well-being. Although access restriction schemes and screens could be effective solutions to limit noise inside urban park areas, preserving their potential regenerative role may engender mobility, social, aesthetic, and architectural issues. Due to the positive effects that natural elements and water sounds can have on human perception, and based on the previous findings of the beneficial effects of audio-visual installations, this paper investigates the possibility of using audio-visual installations that simply evoke some natural features to improve the restoration of individuals inside urban parks. The study has been carried out using immersive virtual environments in two different experimental laboratory sessions in Hong Kong (China) and Aversa (Italy). The results showed that the positive effects provided by evocative installations were similar to those provided by traditional installations. Furthermore, the effects on the restoration increased as the installations became larger and included enveloping shapes. Furthermore, we found that the amount of evocative water installations’ material was responsible for changes in restoration. In contrast, the Chinese groups were less influenced by these installations.

Associations of park access, park use and physical activity in parks with wellbeing in an Asian urban environment: a cross-sectional study

BACKGROUND

Relationships between park access, park use, and wellbeing remain poorly understood. The objectives of this study were to investigate: (1) perceived and objective park access in relation to park use and physical activity in parks; and; (2) perceived and objective park access, park use and physical activity in parks and their associations with wellbeing.

METHODS

An interviewer-assisted survey collected data on perceived time to walk to parks, park use time, park physical activity time and wellbeing (using a scale containing nine domains) amongst adult participants of the Singapore Multi-Ethnic Cohort. Geospatial maps of parks and the "walkable" street networks were created for the city-state of Singapore to objectively determine distances to accessible points on park boundaries. Multiple linear regression models estimated the importance of park access to park use and associations of park access and park use with wellbeing, adjusting for potential confounders.

RESULTS

Participants' (n = 3435) average age was 48.8 years (SD, 12.8), 44.8% were male and 72.6% were of Chinese ethnicity. Better perceived but not true park access was significantly associated with greater park use. Park access (perceived or true) was not associated with physical activity time in parks. Greater participant park time and physical activity time in parks were associated with higher wellbeing scores (p < 0.001). The differences in wellbeing scores between the reference groups, who spent negligible time in parks, and the highest quartiles of time in parks (10.8 h/month) and physical activity in parks (8.3 h/month) were 3.2 (95% CI 2.1-4.4) and 4.2 (95% CI 4.1-6.3) points out of 100 respectively. These associations were similar for most domains of wellbeing, with clear dose-response relationships.

CONCLUSIONS

While perceived park access was strongly associated with park use and well-being, true park access was not, and neither park access measure was associated with park physical activity. Future studies could investigate the influence of park attributes on park use, physical activity in parks and wellbeing. The consistent associations of park use and particularly physical activity in parks with wellbeing suggest that promoting park use, and especially physical activity in parks, is a promising strategy for improving wellbeing in urban settings.

An ecosystem service perspective on urban nature, physical activity, and health

Nature underpins human well-being in critical ways, especially in health. Nature provides pollination of nutritious crops, purification of drinking water, protection from floods, and climate security, among other well-studied health benefits. A crucial, yet challenging, research frontier is clarifying how nature promotes physical activity for its many mental and physical health benefits, particularly in densely populated cities with scarce and dwindling access to nature. Here we frame this frontier by conceptually developing a spatial decision-support tool that shows where, how, and for whom urban nature promotes physical activity, to inform urban greening efforts and broader health assessments. We synthesize what is known, present a model framework, and detail the model steps and data needs that can yield generalizable spatial models and an effective tool for assessing the urban nature-physical activity relationship. Current knowledge supports an initial model that can distinguish broad trends and enrich urban planning, spatial policy, and public health decisions. New, iterative research and application will reveal the importance of different types of urban nature, the different subpopulations who will benefit from it, and nature's potential contribution to creating more equitable, green, livable cities with active inhabitants.

Does surrounding greenness moderate the relationship between apparent temperature and physical activity? Findings from the PHENOTYPE project

BACKGROUND

Physical activity can be affected by both meteorological conditions and surrounding greenness, but few studies have evaluated the effects of these environmental factors on physical activity simultaneously. This multi-city comparative study aimed to assess the synergetic effects of apparent temperature and surrounding greenness on physical activity in four European cities. Specifically, we aimed to identify an interaction between surrounding greenness and apparent temperature in the effects on physical activity.

METHODS

Data were collected from 352 adult residents of Barcelona (Spain), Stoke-on-Trent (United Kingdom), Doetinchem (The Netherlands), and Kaunas (Lithuania) as part of the PHENOTYPE study. Participants wore a smartphone for seven consecutive days between May-December 2013 and provided additional sociodemographic survey data. Hourly average physical activity (Metabolic Equivalent of Task (MET)) and surrounding greenness (NDVI) were derived from the Calfit mobile application collecting accelerometer and location data. Hourly apparent temperature was calculated from temperature and relative humidity, which were obtained from local meteorological stations along with other meteorological covariates (rainfall, windspeed, and sky darkness). We assessed the interaction effects of apparent temperature and surrounding greenness on hourly physical activity for each city using linear mixed models, while adjusting for meteorological, demographic, and time-related variables.

RESULTS

We found significant interactions between apparent temperature and surrounding greenness on hourly physical activity in three of four cities, aside from the coastal city of Barcelona. Significant quadratic effects of apparent temperature were found in the highest level of surrounding greenness for Stoke-on-Trent and Doetinchem, with 4% decrease in median MET observed for a 10°C departure from optimal temperature (15.2°C and 14.6°C, respectively). Significant linear effects were found for higher levels of surrounding greenness in Kaunas, whereby an increase of 10°C was associated with ∼4% increase in median MET.

CONCLUSION

Apparent temperature and surrounding greenness interacted in the effect on hourly physical activity across three of four European cities, with varying effect between cities. While quadratic effects of temperature suggest diminishing levels of physical activity in the highest greenness levels in cities of temperate climates, the variation in surrounding greenness between cities could be further explored, particularly by looking at indoor-outdoor locations. The study findings support the need for evidence-based physical activity promotion and urban design.

Outdoor green space exposure and brain health measures related to Alzheimer's disease: a rapid review

OBJECTIVES

Summarise studies of outdoor green space exposure and brain health measures related to Alzheimer's disease and related disorders (ADRD), and determine scientific gaps for future research.

DESIGN

Rapid review of primary research studies.

METHODS AND OUTCOMES

PubMed, Embase and Web of Science Core Collection were searched for articles meeting the criteria published on/before 13 February 2020. The review excluded papers not in English, focused on transient states (eg, mental fatigue) or not using individual-level measures of brain health (eg, average school test scores). Brain health measures of interest included cognitive function, clinical diagnosis of cognitive impairment/dementia/ADRD and brain biomarkers such as those from MRI, measures typically associated with ADRD risk and disease progression.

RESULTS

Twenty-two papers were published from 2012 to 2020, 36% on <18 years old, 32% on 18-64 years old and 59% on ≥65 years old. Sixty-four per cent defined green space based on the Normalised Difference Vegetation Index ('greenness'/healthy vegetation) and 68% focused on cognitive measures of brain health (eg, memory). Seventeen studies (77%) found green space-brain health associations (14 positive, 4 inverse). Greater greenness/green space was positively associated various cognitive domains in 10 studies and with MRI outcomes (regional brain volumes, cortical thickness, amygdala integrity) in three studies. Greater neighbourhood greenness was associated with lower odds/risk of cognitive impairment/ADRD in some studies but increased odds/risk in others (n=4 studies).

CONCLUSIONS

Published studies suggest positive green space-brain health associations across the life course, but the methods and cohorts were limited and heterogeneous. Future research using racially/ethnically and geographically diverse cohorts, life course methods and more specific green space and brain health measures (eg, time spent in green spaces, ADRD biomarkers) will strengthen evidence for causal associations.

Racial/ethnic and educational differences in perceptions and use of a new urban trail

ABSTRACTObjectives: Obesity and its associated health risks are on the rise throughout the US due, in part, to an overall decline in physical activity. Although public green spaces, and in particular trails, show promise as population-level interventions to promote physical activity among adults, these amenities may have disparate impacts across racial/ethnic and socioeconomic groups within a community.Design: This cross-sectional study employed an intercept survey of users of a newly opened $95 million rail-to-trail development in Chicago, IL, immediately after its opening and one year later to examine differences by race/ethnicity and educational attainment in trail use behaviors, motivations for trail use, safety concerns, and change in physical activity attributed to the trail.Results: Although the overall impact of the trail was positive, Latino users were more likely to report frequent use (4+ times/week), health motivations for using the trail, and increased physical activity attributed to the trail. However, Latino users were also more likely to indicate safety concerns and less likely to use areas of the trail in predominately white communities, even after controlling for community of residence. The least educated trail users frequented fewer trail areas and were less likely to indicate health motivations for trail use.Conclusions: Although urban trails represent an opportunity for cost-effective community-wide health promotion, they may not benefit all groups equally. Urban trails may have particularly promising benefits for Latino users, but safety concerns and the possibility of community racial segregation being replicated on trails should be addressed to maximize and sustain these benefits. Less educated residents in particular may not benefit from such projects as intended.

Associations between the built environment and dietary intake, physical activity, and obesity: A scoping review of reviews

There exists a large body of literature examining the association between built environment factors and dietary intake, physical activity, and weight status; however, synthesis of this literature has been limited. To address this gap, we conducted a scoping review of reviews and identified 74 reviews and meta-analyses that investigated the association between built environment factors and dietary intake, physical activity, and/or weight status. Results across reviews were mixed, with heterogeneous effects demonstrated in terms of strength and statistical significance; however, preliminary support was identified for several built environment factors. For example, quality of dietary intake appeared to be associated with the availability of grocery stores, higher levels of physical activity appeared to be most consistently associated with greater walkability, and lower weight status was associated with greater diversity in land-use mix. Overall, reviews reported substantial concern regarding methodological limitations and poor quality of existing studies. Future research should focus on improving study quality (e.g., using longitudinal methods, including natural experiments, and newer mobile sensing technologies) and consensus should be drawn regarding how to define and measure both built environment factors and weight-related outcomes.

Determining Factors in the Use of Urban Parks That Influence the Practice of Physical Activity in Children: A Systematic Review

The design and/or remodelling of urban parks is a good health strategy to alleviate the lack of physical activity (PA) in children and, consequently, the different health problems derived from this. The main objective of the present study was to obtain a systematic review of the design features and characteristics that influence users’ visits to urban parks and the PA engagement in them. A literature search was carried out in the Web of Science (WOS) and Scopus databases during the months of June and July 2020. After considering and applying inclusion criteria, the final review sample was formed of 31 scientific papers published between 2010–2020. The results obtained in the review lead us to conclude that the needs of the population (children and family members who care for them) and socio-economic context of the area in which they are built must be considered when constructing and/or remodelling parks. Involving community members in playground renovations can have a positive effect on park use and PA engagement in children.

Land use mix and physical activity in middle-aged and older adults: a longitudinal study examining changes in land use mix in two Dutch cohorts

Background

With urbanization and aging increasing in coming decades, societies face the challenge of keeping aging populations active. Land use mix (LUM) has been associated with cycling and walking, but whether changes in LUM relate to changes in cycling/walking is less known.

Objectives

Our objective was to study the effect of LUM on cycling/walking in two Dutch aging cohorts using data with 10 years of follow-up.

Methods

Data from 1183 respondents from the Health and Living Conditions of the Population of Eindhoven and Surroundings (GLOBE) study and 918 respondents from the Longitudinal Aging Study Amsterdam (LASA) were linked to LUM in 1000-m sausage network buffers at three time-points. Cycling/walking outcomes were harmonized to include average minutes spent cycling/walking per week. Data was pooled and limited to respondents that did not relocate between follow-up waves. Associations between LUM and cycling/walking were estimated using a Random Effects Within-Between (REWB) model that allows for the estimation of both within and between effects. Sensitivity analyses were performed on smaller (500-m) and larger (1600-m) buffers.

Results

We found evidence of between-individual associations of LUM in 1000-m buffers and walking (β: 11.10, 95% CI: 0.08; 21.12), but no evidence of within-associations in 1000-m buffers. Sensitivity analyses using 500-m buffers showed similar between-associations, but negative within-associations (β: -35.67, 95% CI: − 68.85; − 2.49). We did not find evidence of between-individual associations of LUM in any buffer size and cycling, but did find evidence of negative within-associations between LUM in 1600-m buffers and cycling (β: -7.49, 95% CI: − 14.31; − 0.66).

Discussion

Our study found evidence of positive associations between LUM and average walking time, but also some evidence of negative associations between a change in LUM and cycling/walking. LUM appears to be related to cycling/walking, but the effect of changes in LUM on cycling/walking is unclear.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01083-1.

Are park availability and satisfaction with neighbourhood parks associated with physical activity and time spent outdoors?

BACKGROUND

There is substantial scope for enhancing population health through increased park visits and active use of parks; however, a better understanding of factors that influence park visitation is needed. This cross-sectional study examined how parent-reported satisfaction and perceived availability of parks were associated with adults' physical activity and children's physical activity and time spent outdoors, and whether these associations were mediated by park visitation.

METHODS

Self-reported surveys were completed by adults living within 5 km of two parks located in Melbourne, Australia. Participants reported their satisfaction with neighbourhood park quality, walking duration from home to the nearest park, and park visitation in the past 7 days. Participants with a child aged 2-15 years also answered similar questions in relation to their child. The primary outcome variable for adults was leisure-time physical activity (LTPA) and for children was proxy-reported time spent outside. The secondary outcome for adults was combined transportation and LTPA and for children (5-15 years) was the number of days physical activity recommendations were met in the past 7 days.

RESULTS

Significant positive associations between park availability and park visitation in the past 7 days, and between park visitation and the outcome variables were observed among both adults (n = 1085, M_age = 48.9, SD 13.4) and children (n = 753, M_age = 8.8, SD = 3.7). The association between park satisfaction and park visitation was only significant among adults. Park visitation mediated associations between park availability and park satisfaction and the outcome variables among both adults and children.

CONCLUSIONS

Improving park availability and users' satisfaction with parks may increase visitation and consequently increase physical activity and time spent outdoors.

ParkIndex: Validation and application of a pragmatic measure of park access and use

Composite metrics integrating park availability, features, and quality for a given address or neighborhood are lacking. The purposes of this study were to describe the validation, application, and demonstration of ParkIndex in four diverse communities. This study occurred in Fall 2018 in 128 census block groups within Seattle(WA), Brooklyn(NY), Raleigh(NC), and Greenville County(SC). All parks within a half-mile buffer were audited to calculate a composite park quality score, and select households provided data about use of proximal parks via an online, map-based survey. For each household, the number of parks, total park acreage, and average park quality score within one half-mile were calculated using GIS. Logistic regression was used to identify a parsimonious model predicting park use. ParkIndex values (representing the probability of park use) were mapped for all study areas and after scenarios involving the addition and renovation/improvement of parks. Out of 360 participants, 23.3% reported visiting a park within the past 30 days. The number of parks (OR = 1.36, 95% CI = 1.15-1.62), total park acreage (OR = 1.13, 95% CI = 1.07-1.19), and average park quality score (OR = 1.04, 95% CI = 1.01-1.06) within one half-mile were all associated with park use. Composite ParkIndex values across the study areas ranged from 0 to 100. Hypothetical additions of or renovations to study area parks resulted in ParkIndex increases of 22.7% and 19.2%, respectively. ParkIndex has substantial value for park and urban planners, citizens, and researchers as a common metric to facilitate awareness, decision-making, and intervention planning related to park access, environmental justice, and community health.

Urban nature and physical activity: Investigating associations using self-reported and accelerometer data and the role of household income

BACKGROUND

Physical inactivity is a major public health concern. Natural, or semi-natural, environments may encourage physical activity, but the influences of socio-economic factors have been under-researched.

METHODS

We explored the associations between meeting physical activity (PA) guidelines and both neighbourhood green (area coverage) and blue (freshwater coverage and coastal proximity) environments for urban adults using data from the Health Survey for England [HSE] (2008/2012). We considered different domains of self-reported PA: walking (n = 18,391), sports and other exercise (n = 18,438), non-recreational (domestic/gardening/occupational; n = 18,446) and all three domains combined (n = 18,447); as well as accelerometer-derived PA data using a subsample (n = 1,774). Relationships were stratified by equivalised household income as an indicator of socio-economic status.

RESULTS

After adjusting for covariates, living <5 km from the coast was associated with significantly higher odds of meeting UK 2010 guidelines through self-reported total, walking and non-recreational PA (e.g. total PA, <5 km vs. >20 km, adjusted odds ratio (OR_adj) = 1.26; 95% confidence interval (CI) = 1.15-1.39) but unrelated to sports and exercise. Greater neighbourhood greenspace, however, was only associated with significantly higher odds of meeting guidelines through non-recreational PA alone (e.g. 80-100% vs. <20% OR_adj = 1.32; 95% CI = 1.12-1.56). Although associations were most consistent in the lowest income quintile, income-related results were mixed. Relationships were not replicated in the smaller accelerometry subsample.

CONCLUSION

Our self-report findings for the differing domains of PA as a function of neighbourhood green and blue space broadly replicated previous research, yet the reasons for the observed differences between PA domains and environments remain unclear. We did not observe any associations between environmental variables and accelerometer-measured PA; further research with larger samples is needed.

Associations between daily ambient temperature and sedentary time among children 4-6 years old in Mexico City

BACKGROUND

Sedentary behavior is a worldwide public health concern. There is consistent and growing evidence linking sedentary behavior to mortality and morbidity. Early monitoring and assessment of environmental factors associated with sedentary behaviors at a young age are important initial steps for understanding children's sedentary time and identifying pertinent interventions.

OBJECTIVE

This study examines the association between daily temperature (maximum, mean, minimum, and diurnal variation) and all-day sedentary time among 4-6 year old children in Mexico City (n = 559) from the year 2013 to 2015.

METHODS

We developed a spatiotemporally resolved hybrid satellite-based land use regression temperature model and calculated percent daily sedentary time from aggregating 10-second epoch vertical counts captured by accelerometers that participants wore for one week. We modeled generalized additive models (GAMs), one for each temperature type as a covariate (maximum, mean, minimum, and diurnal variation). All GAMs included percent all-day sedentary time as the outcome and participant-level random intercepts to account for repeated measures of sedentary time. Our models were adjusted for demographic factors and environmental exposures.

RESULTS

Daily maximum temperature, mean temperature, and diurnal variation have significant negative linear relationships with all-day sedentary time (p<0.01). There is no significant association between daily minimum temperature and all-day sedentary time. Children have on average 0.26% less daily sedentary time (approximately 2.2 minutes) for each 1°C increase in ambient maximum temperature (range 7.1-30.2°C), 0.27% less daily sedentary time (approximately 2.3 minutes) for each 1°C increase in ambient mean temperature (range 4.3-22.2°C), and 0.23% less daily sedentary time (approximately 2.0 minutes) for each 1°C increase in diurnal variation (range 3.0-21.6°C).

CONCLUSIONS

These results are contrary to our hypothesis in which we expected a curvilinear relationship between temperature (maximum, mean, minimum, and diurnal variation) and sedentary time. Our findings suggest that temperature is an important environmental factor that influences children's sedentary behavior.

Neighborhood Social and Built Environment and Disparities in the Risk of Hypertension: A Cross-Sectional Study

Citizens’ participation in urban environmental quality assessment is important when identifying local problems in the sustainable development and environmental planning policy. The principal aim of this study was to analyze whether any social differences exist between the joint effect of built neighborhood quality and exposure to urban green spaces and the risk of hypertension. The study sample consisted of 580 participants residing in 11 districts in Kaunas city, Lithuania. Using geographic information systems (GIS), individual data on the socioeconomic status (SES) and health were linked to the participants’ perceptions of the environmental quality and exposure to green spaces (NDVI). We used multivariate logistic regression to estimate associations as odds ratios (OR). Those study participants with lower education and those study participants with higher education on low incomes rated their health significantly worse. Low SES persons residing in areas with low exposure to green spaces had a significantly higher risk of hypertension when sex, age, family status, smoking, and income were accounted for (OR 1.83, 95% CI 1.01–3.36). This citizen science study provided evidence that the social environment and the quality of the built environment had a complex effect on disparities in the risk of hypertension.

Cross-sectional associations of neighbourhood socioeconomic disadvantage and greenness with accelerometer-measured leisure-time physical activity in a cohort of ageing workers

OBJECTIVE

Neighbourhood characteristics may affect the level of physical activity (PA) of the residents. Few studies have examined the combined effects of distinctive neighbourhood characteristics on PA using objective data or differentiated between activity during working or non-working days. We examined the associations of socioeconomic disadvantage and greenness with accelerometer-measured leisure-time PA during working and non-working days.

DESIGN

Cross-sectional study.

SETTING

Finnish Retirement and Aging (FIREA) study.

PARTICIPANTS

708 workers (604 women, mean age 62.4 ranging from 58 to 64 years,) participating in the FIREA study who provided PA measurement data for at least 1 working and non-working day.

PRIMARY AND SECONDARY OUTCOMES

PA was measured with wrist-worn accelerometer on average of 4 working and 2 non-working days. Outcomes were total PA, light PA (LPA) and moderate-to-vigorous PA (MVPA). These measurements were linked to data on neighbourhood socioeconomic disadvantage and greenness within the home neighbourhood (750×750 m). Generalised linear models were adjusted for possible confounders.

RESULTS

On non-working days, higher neighbourhood disadvantage associated with lower levels of total PA (p value=0.07) and higher level of neighbourhood greenness associated with higher level of total PA (p value=0.04). Neighbourhood disadvantage and greenness had an interaction (p value=0.02); in areas of low disadvantage higher greenness did not associate with the level of total PA. However, in areas of high disadvantage, 2 SD higher greenness associated with 46 min/day (95% CI 8.4 to 85) higher total PA. Slightly stronger interaction was observed for LPA (p=0.03) than for the MVPA (p=0.09). During working days, there were no associations between neighbourhood characteristics and leisure-time total PA.

CONCLUSIONS

Of the disadvantaged neighbourhoods, those characterised by high levels of greenness seem to associate with higher levels of leisure-time PA during non-working days. These findings suggest that efforts to add greenness to socioeconomically disadvantaged neighbourhoods might reduce inequalities in PA.