Built Environment and Active Commuting: Rural-Urban Differences in the U.S

Accelerometer-Measured Physical Activity, Fitness and Indicators of Cardiometabolic Risk among Rural Adolescents: A Cross-Sectional Study at 15-Year Follow-up of the MINIMat Cohort

BACKGROUND

Little is known about the relationship of physical activity (PA) and fitness with cardiometabolic risk among rural adolescents in low- and middle-income countries. Thus, we examined the associations of PA and fitness with selected cardiometabolic indicators along with potential gender-based differences in a birth cohort of rural adolescents from southeast Bangladesh.

METHODS

We utilized data from the 15-year follow-up of Maternal and Infant Nutrition Interventions in Matlab (MINIMat) cohort (n = 2253). Wrist-worn ActiGraph wGT3x-BT accelerometers were used to estimate sedentary time (ST) and PA. Fitness was assessed using: handgrip strength, standing long jump, and Chester Step Test. Anthropometric parameters, systolic blood pressure (SBP), and fasting lipid, insulin and glucose levels were measured. We calculated insulin resistance using the Homeostasis Model Assessment equation (HOMA-IR). Linear regression and isotemporal substitution models were fitted.

RESULTS

The adolescents spent 64 min/day (inter-quartile range: 50-81) in moderate-to-vigorous physical activity (MVPA). A 10-minute-per-day higher vigorous PA (VPA) was associated with: 4.9% (95% confidence interval (CI): 2.9-6.8%) lower waist circumference (WC), 3.2 mmHg (95% CI: 1.5-4.8) lower SBP, 10.4% (95% CI: 2.9-17.3%) lower TG, and 24.4% (95% CI: 11.3-34.9%) lower HOMA-IR. MVPA showed similar associations of notably smaller magnitude. Except for WC, the associations were more pronounced among the boys. Substituting ST with VPA of equal duration was associated with lower WC, SBP, triglyceride and HOMA-IR. Grip strength was favorably associated with all indicators, displaying considerably large effect sizes.

CONCLUSION

Our findings indicated beneficial roles of PA- particularly VPA- and muscular fitness in shaping cardiometabolic profile in mid-adolescence. VPA and grip strength may represent potential targets for preventive strategies tailored to adolescents in resource-limited settings.

Built and natural environment correlates of physical activity of adults living in rural areas: a systematic review

BACKGROUND

According to social-ecological models, the built and natural environment has the potential to facilitate or hinder physical activity (PA). While this potential is well researched in urban areas, a current systematic review of how the built and natural environment is related to PA in rural areas is lacking.

METHODS

We searched five databases and included studies for adults (18-65 years) living in rural areas. We included quantitative studies investigating the association between any self-reported or objectively measured characteristic of the built or natural environment and any type of self-reported or objectively measured PA, and qualitative studies that reported on features of the built or natural environment perceived as barriers to or facilitators of PA by the participants. Screening for eligibility and quality assessment (using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields) were done in duplicate. We used a narrative approach to synthesize the results.

RESULTS

Of 2432 non-duplicate records, 51 quantitative and 19 qualitative studies were included. Convincing positive relationships were found between the availability and accessibility of places for exercise and recreation and leisure-time PA as well as between the overall environment and leisure-time PA. Possible positive associations were found between the overall environment and total and transport-related PA, between greenness/natural environment and total PA, between cycling infrastructure and aesthetics and MVPA, and between pedestrian infrastructure and total walking. A possible negative relationship was found between safety and security and total walking. Qualitative studies complemented several environmental facilitators (facilities for exercise and recreation, sidewalks or streets with low traffic, attractive natural environment) and barriers (lack of facilities and destinations, lack of sidewalks, speeding traffic and high traffic volumes, lack of street lighting).

CONCLUSIONS

Research investigating the relationship between the built and natural environment and PA behaviors of adults living in rural areas is still limited and there is a need for more high-quality and longitudinal studies. However, our most positive findings indicate that investing in places for exercise and recreation, a safe infrastructure for active transport, and nature-based activities are possible strategies that should be considered to address low levels of PA in rural adults.

TRIAL REGISTRATION

PROSPERO: CRD42021283508.

Neighbourhood characteristics and socioeconomic inequalities in child mental health: Cross-sectional and longitudinal findings from the Growing Up in Ireland study

This study examined the role of neighbourhood characteristics in explaining socioeconomic inequalities in child mental health (the total difficulties score from the Strengths and Difficulties Questionnaire) using data from Cohort '08 of Growing Up in Ireland Waves 3 (age 5; baseline) and 5 (age 9; follow-up). Twenty neighbourhood items were grouped into neighbourhood safety, built environments, cohesion, interaction, and disorder. Data were analysed using regression, single and multiple mediation, and network psychometric analyses. We found that neighbourhood safety, cohesion, interaction, and disorder were associated with child mental health. These four domains separately (by up to 18 %) or in concert (by up to 23 %) partially explained socioeconomic inequalities in child mental health. Built environments may explain socioeconomic inequalities in mental health in urban children only. Findings from network analysis indicated that specific concerns over "people being drunk or taking drugs in public" and "this is a safe neighbourhood" had the strongest connections with child mental health. Improving neighbourhood characteristics may be important to reduce socioeconomic inequalities in child mental health in Ireland.

Assessing the association between food environment and dietary inflammation by community type: a cross-sectional REGARDS study

BACKGROUND

Communities in the United States (US) exist on a continuum of urbanicity, which may inform how individuals interact with their food environment, and thus modify the relationship between food access and dietary behaviors.

OBJECTIVE

This cross-sectional study aims to examine the modifying effect of community type in the association between the relative availability of food outlets and dietary inflammation across the US.

METHODS

Using baseline data from the REasons for Geographic and Racial Differences in Stroke study (2003-2007), we calculated participants' dietary inflammation score (DIS). Higher DIS indicates greater pro-inflammatory exposure. We defined our exposures as the relative availability of supermarkets and fast-food restaurants (percentage of food outlet type out of all food stores or restaurants, respectively) using street-network buffers around the population-weighted centroid of each participant's census tract. We used 1-, 2-, 6-, and 10-mile (~ 2-, 3-, 10-, and 16 km) buffer sizes for higher density urban, lower density urban, suburban/small town, and rural community types, respectively. Using generalized estimating equations, we estimated the association between relative food outlet availability and DIS, controlling for individual and neighborhood socio-demographics and total food outlets. The percentage of supermarkets and fast-food restaurants were modeled together.

RESULTS

Participants (n = 20,322) were distributed across all community types: higher density urban (16.7%), lower density urban (39.8%), suburban/small town (19.3%), and rural (24.2%). Across all community types, mean DIS was - 0.004 (SD = 2.5; min = - 14.2, max = 9.9). DIS was associated with relative availability of fast-food restaurants, but not supermarkets. Association between fast-food restaurants and DIS varied by community type (P for interaction = 0.02). Increases in the relative availability of fast-food restaurants were associated with higher DIS in suburban/small towns and lower density urban areas (p-values < 0.01); no significant associations were present in higher density urban or rural areas.

CONCLUSIONS

The relative availability of fast-food restaurants was associated with higher DIS among participants residing in suburban/small town and lower density urban community types, suggesting that these communities might benefit most from interventions and policies that either promote restaurant diversity or expand healthier food options.

The role of the perceived environment for recreational walking among adults in socioeconomically disadvantaged situations: A study using walk-along interviews

Background

Persons in socioeconomically disadvantaged situations (PSEDS) are generally less likely to engage in recreational walking (RW) compared to higher socioeconomic groups and are often more dependent on their local environment. Studies on RW have primarily focused on the role of the built environment for the general adult population and the older population in urban areas. The aim of this study is to qualitatively identify the perceived environmental factors affecting RW among PSEDS in peri-urban areas.

Methods

In two peri-urban municipalities in Belgium, walk-along interviews were conducted until data saturation with a purposeful convenience sampling of 38 PSEDS (25-65y/o) to identify local environmental factors affecting RW. A subsample of 22 participants joined a focus group (n = 4) to categorize the identified factors into environmental types (physical, sociocultural, political, and economic) of the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. The interviews were transcribed and analyzed thematically using Maxqda 2022.0.

Results

The information environment (dissemination, retrieving and understanding of information) was added to the ANGELO framework, highlighting the importance of digital literacy. Availability and accessibility of well-maintained walking surfaces, toilets, street lighting and seating options (physical environment), social support, dog-ownership, stigmatization, social isolation, and a sense of belonging (sociocultural environment) and indirect costs (economic environment) were identified as important environmental factors in RW among PSEDS. The identified political and economic factors are intertwined with the other environments.

Conclusions

Perceived environmental factors affect RW among PSEDS and peri-urban settings offer specific challenges. Local governments should incorporate citizen perception into decision-making processes to create supportive environments that have the potential to promote RW among PSEDS in a peri-urban setting.

Urban-rural disparities in childhood obesogenic environments in the United States: Application of differing rural definitions

BACKGROUND

Research is needed that identifies environmental resource disparities and applies multiple rural definitions. Therefore, this study aims to examine urban-rural differences in food and physical activity (PA) environment resource availability by applying several commonly used rural definitions. We also examine differences in resource availability within urban-rural categories that are typically aggregated.

METHODS

Six food environment variables (access to grocery/superstores, farmers' markets, fast food, full-service restaurants, convenience stores, and breastfeeding-friendly facilities) and 4 PA environment variables (access to exercise opportunities and schools, walkability, and violent crimes) were included in the childhood obesogenic environment index (COEI). Total COEI, PA environment, and food environment index scores were generated by calculating the average percentile for related variables. US Department of Agriculture Urban Influence Codes, Office of Management and Budget codes, Rural-Urban Continuum Codes, Census Bureau Population Estimates for percent rural, and Rural Urban Commuting Area Codes were used. One-way ANOVA was used to detect urban-rural differences.

RESULTS

The greatest urban-rural disparities in COEI (F=310.2, P<.0001) and PA environment (F=562.5, P<.0001) were seen using RUCC codes. For food environments, the greatest urban-rural disparities were seen using Census Bureau percent rural categories (food: F=24.9, P<.0001). Comparing remote rural categories, differences were seen for food environments (F=3.1, P=.0270) and PA environments (F=10.2, P<.0001). Comparing metro-adjacent rural categories, differences were seen for PA environment (F=4.7, P=.0090).

CONCLUSION

Findings inform future research on urban and rural environments by outlining major differences between urban-rural classifications in identifying disparities in access to health-promoting resources.

Social Inequalities in the Association between Social Infrastructure and Mental Health: An Observational Cross-Sectional Analysis of Children and Adolescents in Germany

The mental health (MH) of especially children and adolescents with low socioeconomic status (SES) benefits from access to greenspaces. This study aimed at investigating social inequalities in the association between several types of social infrastructure (SI) and MH in children and adolescents. The sample comprised 12,624 children and adolescents of the KiGGS Wave 2 study (2014-2017). KiGGS provided information on SI (access to playgrounds, sports fields, swimming pools, parks) for all children and the environmental module (GerES V) within KiGGS on the walking time to SI for a subsample. Social inequality was measured by parental SES and the German Index of Socioeconomic deprivation and MH by the Strengths and Difficulties Questionnaire. Ordinal logistic regression analyses showed that access to fewer SI places was associated with higher odds of MH problems. Children and adolescents experiencing high (but not medium or low) socioeconomic deprivation at the municipal level were more likely to have MH problems when having less access to SI places. At the individual level, MH problems in high- and low-SES, but not medium-SES children and adolescents were associated with no access to SI places. Children and adolescents from high socioeconomically deprived areas and with low and high SES might benefit from high-availability SI.

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

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

Cost of Living Variation, Nonmetropolitan America, and Implications for the Supplemental Poverty Measure

Poverty scholarship in the United States is increasingly reliant upon the Supplemental Poverty Measure (SPM) as opposed to the Official Poverty Measure of the United States for research and policy analysis. However, the SPM still faces several critiques from scholars focused on poverty in nonmetropolitan areas. Key among these critiques is the geographic adjustment for cost of living employed in the SPM, which is based solely upon median rental costs and pools together all nonmetropolitan counties within each state. Here, we evaluate the current geographic adjustment of the SPM using both microdata and aggregate data from the American Community Survey for 2014-2018. By comparing housing costs, tenure, and commuting, we determine that median rent is likely an appropriate basis for geographic adjustment. However, by demonstrating the wide variability between median rents of nonmetropolitan counties within the same state, we show that the current operationalization of this geographic adjustment could be improved through the use of more-specific categories such as metropolitan adjacency or Rural Urban Continuum Codes.

Categorizing community type for epidemiologic evaluation of community factors and chronic disease across the United States

Existing classifications of community type do not differentiate urban cores from surrounding non-rural areas, an important distinction for analyses of community features and their impact on health. Inappropriately classified community types can introduce serious methodologic flaws in epidemiologic studies and invalid inferences from findings. To address this, we evaluate a modification of the United States Department of Agriculture's Rural Urban Commuting Area codes at the census tract, propose a four-level categorization of community type, and compare this with existing classifications for epidemiologic analyses. Compared to existing classifications, our method resulted in clearer geographic delineations of community types within urban areas.

Rural-Urban Disparities In All-Cause Mortality Among Low-Income Medicare Beneficiaries, 2004-17

There is growing concern about the health of older US adults who live in rural areas, but little is known about how mortality has changed over time for low-income Medicare beneficiaries residing in rural areas compared with their urban counterparts. We evaluated whether all-cause mortality rates changed for rural and urban low-income Medicare beneficiaries dually enrolled in Medicaid, and we studied disparities between these groups. The study cohort included 11,737,006 unique dually enrolled Medicare beneficiaries. Between 2004 and 2017 all-cause mortality declined from 96.6 to 92.7 per 1,000 rural beneficiaries (relative percentage change: -4.0 percent). Among urban beneficiaries, declines in mortality were more pronounced (from 86.9 to 72.8 per 1,000 beneficiaries, a relative percentage change of -16.2 percent). The gap in mortality between rural and urban beneficiaries increased over time. Rural mortality rates were highest in East North Central states and increased modestly in West North Central states during the study period. Public health and policy efforts are urgently needed to improve the health of low-income older adults living in rural areas.

Projecting the Influence of Global Warming on Physical Activity Patterns: a Systematic Review

PURPOSE OF REVIEW

This study systematically identified and synthesized empirical data-driven modeling studies that projected the future influence of global warming on people's physical activity patterns.

RECENT FINDINGS

A total of ten studies met the eligibility criteria and were included in the review. Global warming, in general, was predicted to be associated with a net increase in active commuting and leisure-time physical activity. However, the specific relationship between climate change and future physical activity patterns was expected to vary by the periods of prediction, geographical locations, population subgroups, and seasons. Moreover, the positive association between global warming and physical activity could level off or be reversed once reaching a temperature threshold. Preliminary evidence suggested a net increase in physical activity by mid- to late-twenty-first century owing to global warming. Future studies should refine the projections by taking into account the indirect effect of global warming through induced natural and human events, and assess effective countermeasures to mitigate the negative impact of global warming on vulnerable population subgroups.

Environmental determinants of population health in urban settings. A systematic review

Background

Population health is influenced by interactions between environmental determinants, which are captured by dimensions and indicators. This study aims to systematically review key environmental determinants and respective dimensions and indicators, relevant to evaluate population health in urban settings, and to understand their potential implications into policies.

Methods

A search of literature published between 2008 and 2018 was conducted in PubMed, Web of Science, Scopus and SciELO Portugal databases, on studies with evidence on association between an environmental determinant and a health outcome in urban contexts. Health determinants, dimensions and indicators researched in the selected studies were synthetized, and associations analyzed. An independent assessment of quality of the studies was performed. Key conclusions and policy recommendations were extracted to build a framework to analyze environment related population health and policies in urban settings.

Results

Ninety four studies of varied methodological approaches and quality met the inclusion criteria. The review identified positive associations between all environmental determinants -socioeconomic, built environment, natural environment, healthcare, behaviors, and health outcomes - overall mortality and morbidity, in urban settings. Improvements in income, education, air quality, occupation status, mobility and smoking habits indicators have positive impact in overall mortality and chronic diseases morbidity indicators. Initiatives to improve population health in which policymakers can be more evidence-informed include socioeconomic, natural environment and built environment determinants.

Conclusions

There is scope and need to further explore which environmental determinants and dimensions most contribute to population health to create a series of robust evidence-based measures to better inform urban planning policies.

Cross-sectional and longitudinal analysis of the active commuting behaviors of U.S. Department of the Interior employees

BACKGROUND

Despite evolving evidence of the health and economic benefits of active transportation (AT) to work, few studies have examined the determinants of AT in large organizations with multiple worksites nor how trends in commuting change over time.

METHODS

The data were obtained from the U.S. Department of the Interior Employee Commuting Census of 2010 (n = 23,230), and 2012-2016 (n = 21,725-25,974). The respondents were grouped into four commuting categories: non-active mode, walking, biking, and mixed-mode. Multinomial logistic regression analysis was utilized to examine the correlates of choosing AT to work for the 2010 data. Next, a repeated cross-sectional analysis was completed for all six years of data.

RESULTS

In 2010, AT modes were only chosen by approximately 10% of respondents. Employees who lived farther from work and did not have a public transit station within 0.5 miles from home were generally less likely to choose AT. Respondents working in non-metro workplaces were less likely to bike or take mixed-modes to work, but more likely to walk. Men were more likely to choose AT modes, particularly biking. Respondents aged ≤30 yrs. were less likely to bike than those 31 to 40 yrs., but more likely than those ≥61 yrs. In 2010, the number of respondents that walked was higher, and biked and took mixed-modes was lower when compared to 2016, while the choice to take mixed-modes was higher in 2012 and 2013 when compared to 2016. Daily commuting distances in 2016 tended to be lower than 2010 and 2012, and higher than 2013. However, overall AT choice and commute distance remained reasonably stable over time.

CONCLUSIONS

Respondents who lived close to their workplace and a public transportation station, worked in a metro location, were male and younger were more likely to choose AT modes to work. The results provide insight for the U.S. Department of the Interior and other large organizations to develop intervention strategies that support AT to work. Further research is warranted to understand the concurrent individual, social, and environmental barriers and facilitators for choosing AT to work.

A scoping review of simulation modeling in built environment and physical activity research: Current status, gaps, and future directions for improving translation

Existing reviews have suggested that simulation studies of physical activity and environments are an emerging area, but none have explored findings in this area systematically. We used a scoping review framework to assess the use of simulation modeling to inform decision-making about built environment influences on physical activity. A systematic literature search was conducted in multiple databases in January 2018. Sixteen articles met the inclusion criteria. The studies evaluated interventions and features that were related to neighborhood safety (crime or traffic), active transportation, land use design, and walking and biking infrastructure. All of the studies focused on urban areas and most considered heterogeneity of outcomes based on local context. The majority of studies (70%) did not appear to have engaged or been used by practitioners or policy-makers to inform real-world decisions. There has been a growth of simulation modeling studies, but there remain gaps. The studies evaluated built environment interventions that have been recommended by expert panels, but more were of interventions related to active transportation; few considered recommended interventions to support recreational activity. Furthermore, studies have all focused on urban settings and there is a need to consider non-urban settings and how heterogeneity could reduce or exacerbate health disparities. More work to involve and evaluate practices for engaging stakeholders in model development and interpretation is also needed to overcome the translation of simulation research to practice gap, and realize its potential impact on the built environment and physical activity.

Association of School Physical Activity Policies With Student Physical Activity Behavior

Background: Few studies have examined school physical activity policies to assess dose-response on student outcomes. The purpose of this study was to evaluate the association between health-promoting physical activity policies in elementary schools and physical activity behavior. Methods: In this cross-sectional study, physical activity was assessed using self-report measures in fourth-grade students in Texas (N = 1958, x = 9.66 y) from the School Physical Activity and Nutrition (SPAN) survey. School policies were assessed using the number of health-promoting policies in place taken from the SPAN School Health Survey with principals and their proxies. Multiple linear regressions adjusted for student- and school-level confounders and school clustering were performed. Results: School physical activity policies were significantly associated with student-level physical activity behavior (P < .05), even after controlling for the student- and school-level confounding variables. The interactions between physical activity policy-by-economic disadvantage (P < .01) and between physical activity policy-by-geographic strata (P < .01) were both significant, with stronger direct effects of policies on student physical activity for economically disadvantaged schools and major urban schools. Conclusion: Results from this study provide evidence for the importance of school-based health policies and practices in potentially reducing health disparities, especially in low-income and urban schools.

HPV Vaccination Coverage Among US Teens Across the Rural-Urban Continuum

BACKGROUND

In this study, we used data from the National Immunization Survey-Teen (NIS-Teen) to examine HPV vaccination uptake by rural and urban residence defined by ZIP code.

METHODS

We used 2012-2013 NIS-Teen data to examine associations of HPV vaccination among teens aged 13-17 years with ZIP code measures of rural/urban (Rural-Urban Commuting Area (RUCA) codes, population density). Multivariable logistic regression was used to estimate the odds of HPV vaccination initiation (≥ 1 dose) and completion (≥ 3 doses).

RESULTS

HPV vaccination was lower among girls from isolated small rural towns (≥1 dose 51.0%; ≥3 doses 30.0%) and small rural towns (≥1 dose 50.2%; ≥3 doses 26.8%) than among urban girls (≥1 dose 56.0%; ≥3 doses 35.9%). Girls from small rural towns had lower odds of completion (0.74, 95% CI: 0.60-0.91) than girls from urban areas. HPV vaccination was lower among boys from isolated small rural towns (≥1 dose 17.3%; ≥3 doses 5.31%) and small rural towns (≥1 dose 18.7%; ≥3 doses 5.50%) than those in urban areas (≥1 dose 28.7%; ≥3 doses 10.7%). Boys in isolated small rural towns had statistically significantly lower odds of initiation (0.68, 95% CI: 0.52-0.88) and completion (0.63, 95% CI: 0.41-0.97) than urban boys. Girls and boys from high-poverty rural areas had lower odds of initiation and completion than did their counterparts from high-poverty urban areas.

CONCLUSION

Rural girls had lower odds of completing the HPV vaccine than their urban counterparts. Rural boys had lower odds than urban boys for HPV vaccination initiation and completion.