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Vilcins D, Sly PD, Scarth P, Mavoa S. Green space in health research: an overview of common indicators of greenness. REVIEWS ON ENVIRONMENTAL HEALTH 2024; 39:221-231. [PMID: 36372560 DOI: 10.1515/reveh-2022-0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Dwan Vilcins
- Children's Health and Environment Program, The University of Queensland, Brisbane, Australia
| | - Peter D Sly
- Children's Health and Environment Program, The University of Queensland, Brisbane, Australia
| | - Peter Scarth
- School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Australia
| | - Suzanne Mavoa
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Wende ME, Hughey SM, McLain AC, Hallum S, Hipp JA, Schipperijn J, Stowe EW, Kaczynski AT. Identifying multilevel predictors of behavioral outcomes like park use: A comparison of conditional and marginal modeling approaches. PLoS One 2024; 19:e0301549. [PMID: 38626162 PMCID: PMC11020402 DOI: 10.1371/journal.pone.0301549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/18/2024] [Indexed: 04/18/2024] Open
Abstract
This study compared marginal and conditional modeling approaches for identifying individual, park and neighborhood park use predictors. Data were derived from the ParkIndex study, which occurred in 128 block groups in Brooklyn (New York), Seattle (Washington), Raleigh (North Carolina), and Greenville (South Carolina). Survey respondents (n = 320) indicated parks within one half-mile of their block group used within the past month. Parks (n = 263) were audited using the Community Park Audit Tool. Measures were collected at the individual (park visitation, physical activity, sociodemographic characteristics), park (distance, quality, size), and block group (park count, population density, age structure, racial composition, walkability) levels. Generalized linear mixed models and generalized estimating equations were used. Ten-fold cross validation compared predictive performance of models. Conditional and marginal models identified common park use predictors: participant race, participant education, distance to parks, park quality, and population >65yrs. Additionally, the conditional mode identified park size as a park use predictor. The conditional model exhibited superior predictive value compared to the marginal model, and they exhibited similar generalizability. Future research should consider conditional and marginal approaches for analyzing health behavior data and employ cross-validation techniques to identify instances where marginal models display superior or comparable performance.
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Affiliation(s)
- Marilyn E. Wende
- Department of Health Education & Behavior, College of Health & Human Performance, University of Florida, Gainesville, FL, United States of America
| | - S. Morgan Hughey
- Department of Health and Human Performance, School of Health Sciences, College of Charleston, Charleston, SC, United States of America
| | - Alexander C. McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Shirelle Hallum
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - J. Aaron Hipp
- Department of Parks, Recreation, and Tourism Management, Center for Geospatial Analytics, North Carolina State University, Raleigh, NC, United States of America
| | - Jasper Schipperijn
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ellen W. Stowe
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Andrew T. Kaczynski
- Department of Health Promotion, Education, and Behavior, Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
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Hallum SH, Wende ME, Hesam Shariati F, Thomas KM, Chupak AL, Witherspoon E, Kaczynski AT. Unearthing Inequities in the Relationship between Multiple Sociodemographic Factors and Diverse Elements of Park Availability and Quality in a Major Southern Metropolitan Region. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:204. [PMID: 38397693 PMCID: PMC10888646 DOI: 10.3390/ijerph21020204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Parks are critical components of healthy communities. This study explored neighborhood socioeconomic and racial/ethnic inequalities in park access and quality in a large U.S. southeastern metropolitan region. A total of 241 block groups were examined, including 77 parks. For each block group, we obtained multiple sociodemographic indicators, including unemployment rate, education level, renter-occupied housing, poverty rate, and racial/ethnic minority composition. All parks were mapped using geographical information systems and audited via the Community Park Audit Tool to evaluate their features and quality. We analyzed seven diverse elements of park quality (transportation access, facility availability, facility quality, amenity availability, park aesthetics, park quality concerns, and neighborhood quality concerns), as well as an overall park quality score by calculating the mean for all parks within each block group. The mean percent of residents below 125% of the poverty level and the percentage of renter-occupied housing units were significantly higher among block groups with any parks in comparison to block groups with no parks. In addition, there were significant positive associations between park transportation access scores and both the percentage of residents with less than high school education and the percent identifying as non-Hispanic white. Moreover, there was a significant negative association between park amenity availability and the block group's unemployed population. Further, a significant negative association between park aesthetics and the population with a lower than high school education percentage was observed. Revealed differences in park availability, park acreage, and park quality dimensions emphasized the need for targeted policy, programmatic, and infrastructure interventions to improve park access and quality and address health disparities.
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Affiliation(s)
- Shirelle H. Hallum
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (S.H.H.); (F.H.S.); (K.M.T.); (A.L.C.); (E.W.)
| | - Marilyn E. Wende
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL 32608, USA;
| | - Farnaz Hesam Shariati
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (S.H.H.); (F.H.S.); (K.M.T.); (A.L.C.); (E.W.)
| | - Kelsey M. Thomas
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (S.H.H.); (F.H.S.); (K.M.T.); (A.L.C.); (E.W.)
| | - Anna L. Chupak
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (S.H.H.); (F.H.S.); (K.M.T.); (A.L.C.); (E.W.)
| | - Eleanor Witherspoon
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (S.H.H.); (F.H.S.); (K.M.T.); (A.L.C.); (E.W.)
| | - Andrew T. Kaczynski
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (S.H.H.); (F.H.S.); (K.M.T.); (A.L.C.); (E.W.)
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Hernández ED, Cobo EA, Cahalin LP, Seron P. Impact of structural-level environmental interventions on physical activity: a systematic review. Int Arch Occup Environ Health 2023:10.1007/s00420-023-01973-w. [PMID: 37099193 DOI: 10.1007/s00420-023-01973-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/30/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To determine the effectiveness of structural-level environmental interventions on the changes in PA levels in the populations examined. METHODS Natural experiments that involve environmental intervention with structural modification were included. The primary outcome PA levels with consideration of both objective and subjective measurements. An electronic search was carried out in Medline/Pubmed, SCIENCE DIRECT, WEB OF SCIENCE, and CINAHL up to January 2022. Two reviewers screened titles and abstracts, selected studies, extracted relevant data, and examined study quality. A qualitative synthesis was performed. RESULTS Twenty-six articles were included. The structural-level environmental interventions included 4 fundamental areas: schools, work environments, streets or cities, and neighborhoods or parks. Of the 26 studies, 21 examined outdoor environments like parks, cities, pedestrian walkways, or steps, while 5 examined indoor or closed environments like schools and workplaces revealing that structural-level environmental interventions improve PA levels with the greatest effect in parks and active transportation. A risk of bias is inherent in natural experiments which is a limitation of this study. In schools and work areas, there is evidence of both decrease in sedentary time and an increase in PA related to environmental modifications. CONCLUSION Structural-level environmental modifications in parks and active transportation demonstrated greater effects in promoting PA. Environmental modifications can impact physical activity in the population. Given that the economic and cultural setting is a key variable when considering the effectiveness of structural interventions, and since only 1 of the 26 reviewed articles included such data, more studies examining economic factors are needed especially in low- and middle-income countries like in South America. TRIAL REGISTRATION PROSPERO CRD42021229718.
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Affiliation(s)
- Edgar D Hernández
- Facultad de Medicina, Human Movement Department, Universidad Nacional de Colombia, cra 45 30-00, Bogotá, Colombia.
| | - Elisa A Cobo
- Facultad de Ciencias de la Salud, Universidad de Boyacá, Boyacá, Tunja, Colombia
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami, Miami, Florida, USA
| | - Pamela Seron
- Facultad de Medicina, Universidad de La Frontera, Claro Solar #112, Temuco, Chile
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Robinson T, Robertson N, Curtis F, Darko N, Jones CR. Examining Psychosocial and Economic Barriers to Green Space Access for Racialised Individuals and Families: A Narrative Literature Review of the Evidence to Date. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:745. [PMID: 36613069 PMCID: PMC9819928 DOI: 10.3390/ijerph20010745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Social prescribing (such as green social prescribing), aims to address health disparities cross-culturally to improve well-being. However, evidence highlights racial disparities in relation to access to quality green space (including local/national parks and recreational spaces). This review aimed to identify the psycho-socioeconomic barriers to green space access for racialised individuals/families and Black Indigenous People of Colour (BIPOC), to understand what cultural adaptations might be made to help support them to access green social prescribing within the UK. METHOD A narrative systematic review was conducted to identify barriers to green space access for racialised individuals/families and BIPOC. Searches of publication databases (APA PsycInfo, Cochrane Database of Systematic Reviews [CDSR], Cochrane Central Register of Controlled Trials [CENTRAL], Cumulated Index to Nursing and Allied Health Literature [CINAHL], and SCOPUS Preview) were undertaken from January to February 2022, to identify quantitative peer reviewed studies. Of the 4493 abstracts identified, ten studies met the inclusion criteria and were included for final review. RESULTS The results suggest that interpersonal, practical (such as transportation costs, entrance fees and lodging costs) and environmental factors can act as barriers to green space access for racialised individuals/families. Most frequently reported barriers were perceptions of safety and costs associated with travel and accessing green spaces, particularly for families. CONCLUSION Factors such as diversity-friendly schemes (e.g., multiple languages on signs and additional prayer spaces in parks), funding and strategies to improve safety should be considered in the design and commissioning of green space and green social prescribing initiatives in primary care. By mitigating these barriers green space can become more accessible and improve inclusivity for racialised individuals/families. Future research could explore the inter-racial differences between racialised populations and which mechanisms reduce barriers to access and in what contexts.
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Affiliation(s)
- Tila Robinson
- Department of Psychology and Vison Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Noelle Robertson
- Department of Psychology and Vison Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Ffion Curtis
- Centre for Ethnic Health, University of Leicester, Leicester LE1 7RH, UK
| | - Natalie Darko
- School of Sociology, University of Leicester, Leicester LE1 7RH, UK
| | - Ceri R. Jones
- Department of Psychology and Vison Sciences, University of Leicester, Leicester LE1 7RH, UK
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Xu Y, Wheeler SA, Zuo A. The Effectiveness of Interventions to Increase Participation and Physical Activities in Parks: A Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12590. [PMID: 36231890 PMCID: PMC9566024 DOI: 10.3390/ijerph191912590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/23/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Although a variety of interventions in many countries have been developed to increase park use and to improve public participation in physical activities in parks, knowledge of their overall effectiveness is lacking. A systematic literature review was undertaken to further understand the effectiveness of various interventions that aim to increase the use of parks and physical activity participation in parks. This systematic review utilized the standard Preferred Reporting Items for Systematic Reviews and Meta-Analysis procedure, and of the 3801 studies identified, 60 studies were reviewed in-depth, with 44 studies assessed for quality of evidence and risk of bias. Most of the 44 reviewed studies found that various interventions had positive impacts on park use and physical activity participation in parks. Interventions were classified into both demand and supply, with more studies focusing on the supply side. The strongest evidence on the effectiveness of various interventions was found for park prescriptions; safe access to parks; playgrounds, and park renovation and renewal/design. However, the assessment of quality of evidence and risk of bias showed that most studies suffer from potential biases and evidence weaknesses, suggesting a need to further establish external validity.
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Affiliation(s)
- Ying Xu
- School of Economics and Public Policy, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Sarah Ann Wheeler
- School of Economics and Public Policy, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Alec Zuo
- School of Economics and Public Policy, The University of Adelaide, Adelaide, SA 5005, Australia
- The Centre for Global Food and Resources, School of Economics and Public Policy, The University of Adelaide, Adelaide, SA 5005, Australia
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Ma M, Adeney M, Chen W, Deng D, Tan S. To Create a Safe and Healthy Place for Children: The Associations of Green Open Space Characteristics With Children's Use. Front Public Health 2022; 9:813976. [PMID: 35368510 PMCID: PMC8966046 DOI: 10.3389/fpubh.2021.813976] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/06/2021] [Indexed: 12/03/2022] Open
Abstract
Green open space (GOS) is an important outdoor resource for the well-being of children by providing places for physical activity (PA), especially in the highly urbanized environment. The COVID-19 lockdowns have made children have more sedentary time than before due to less access to public places. This article aims to examine the associations of GOS characteristics (environmental and surrounding) and children's use (visitation and PA pattern) to provide evidence for promoting their PA during the pandemic. This study employed the method of GPS positioner, accelerometer, and survey to measure the children's actual use in GOS. A total of 179 children participated in the study and 10 GOSs were selected. The children were provided with the accelerometers and GPS positioners to track their walking steps, duration, and locations. The environmental characteristics and 1 km buffer of the selected GOSs were explored as extended study area. Results showed that 49.16% of children reported more visitations than before the pandemic, and 48.60% of them preferred to go on weekdays during the pandemic. Both environmental and surrounding characteristics could affect the visitation pattern. The size (p < 0.000), residential ratio (p < 0.000), and intersection density (p < 0.000) were found as the factors significantly associated with visitation pattern. The children's PA pattern was mainly associated with the environmental characteristics of size (p < 0.000), sports, and playground proportion (p < 0.000). The locations of children's PA were mainly around square, playground, sheltered place, and waterside areas. COVID-19 has transformed the children's use of GOS, as well as their relationship with GOS. The large GOS was more likely to promote PA and its use by the children. The environmental and surrounding characteristics of GOS could affect their use pattern, whereas their PA pattern was mainly associated with the environmental characteristics. The findings suggest that GOS characteristics could be an effective solution to respond the challenge from the pandemic, and promote their visitation and PA.
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Affiliation(s)
- Ming Ma
- College of Architecture and Urban Planning, Yunnan University, Yunnan, China
- Institute for Smart City of Chongqing University in Liyang, Chongqing University, Chongqing, China
- Faculty of Architecture and Urban Planning, Chongqing University, Chongqing, China
- *Correspondence: Ming Ma
| | - Michael Adeney
- School of Public Health, University of Washington, Seattle, WA, United States
| | - Wei Chen
- Department of Bone and Joint Surgery, Sanya Central Hospital, Sanya, China
| | - Darong Deng
- The First Studio, Chongqing Planning and Design Institute, Chongqing, China
| | - Shaohua Tan
- Faculty of Architecture and Urban Planning, Chongqing University, Chongqing, China
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Measuring the Differences of Public Health Service Facilities and Their Influencing Factors. LAND 2021. [DOI: 10.3390/land10111225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The equitable distribution of public health facilities is a major concern of urban planners. Previous studies have explored the balance and fairness of various medical resource distributions using the accessibility of in-demand public medical service facilities while ignoring the differences in the supply of public medical service facilities. First aid data with location information and patient preference information can reflect the ability of each hospital and the health inequities in cities. Determining which factors affect the measured differences in public medical service facilities and how to alter these factors will help researchers formulate targeted policies to solve the current resource-balance situation of the Ministry of Public Health. In this study, we propose a method to measure the differences in influence among hospitals based on actual medical behavior and use geographically weighted regression (GWR) to analyze the spatial correlations among the location, medical equipment, medical ability, and influencing factors of each hospital. The results show that Wuhan presents obvious health inequality, with the high-grade hospitals having spatial agglomeration in the city-center area, while the number and quality of hospitals in the peripheral areas are lower than those in the central area; thus, the hospitals in these peripheral areas need to be further improved. The method used in this study can measure differences in the influence of public medical service facilities, and the results are consistent with the measured differences at hospital level. Hospital influence is not only related to the equipment and medical ability of each hospital but is also affected by location factors. This method illustrates the necessity of conducting more empirical research on the public medical service supply to provide a scientific basis for formulating targeted policies from a new perspective.
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Fyfe-Johnson AL, Hazlehurst MF, Perrins SP, Bratman GN, Thomas R, Garrett KA, Hafferty KR, Cullaz TM, Marcuse EK, Tandon PS. Nature and Children's Health: A Systematic Review. Pediatrics 2021; 148:e2020049155. [PMID: 34588297 DOI: 10.1542/peds.2020-049155] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Daily outdoor play is encouraged by the American Academy of Pediatrics. Existing evidence is unclear on the independent effect of nature exposures on child health. OBJECTIVE We systematically evaluated evidence regarding the relationship between nature contact and children's health. DATA SOURCES The database search was conducted by using PubMed, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, ERIC, Scopus, and Web of Science in February 2021. STUDY SELECTION We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In all searches, the first element included nature terms; the second included child health outcome terms. DATA EXTRACTION Of the 10 940 studies identified, 296 were included. Study quality and risk of bias were assessed. RESULTS The strongest evidence for type of nature exposure was residential green space studies (n = 147, 50%). The strongest evidence for the beneficial health effects of nature was for physical activity (n = 108, 32%) and cognitive, behavioral, or mental health (n = 85, 25%). Physical activity was objectively measured in 55% of studies, and 41% of the cognitive, behavioral, or mental health studies were experimental in design. LIMITATIONS Types of nature exposures and health outcomes and behaviors were heterogenous. Risk of selection bias was moderate to high for all studies. Most studies were cross-sectional (n = 204, 69%), limiting our ability to assess causality. CONCLUSIONS Current literature supports a positive relationship between nature contact and children's health, especially for physical activity and mental health, both public health priorities. The evidence supports pediatricians in advocating for equitable nature contact for children in places where they live, play, and learn.
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Affiliation(s)
- Amber L Fyfe-Johnson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | | | | | - Gregory N Bratman
- School of Environmental and Forest Sciences, University of Washington, Seattle, Washington
| | - Rick Thomas
- National Academy of Sciences, Washington, District of Columbia
| | - Kimberly A Garrett
- Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington
| | - Kiana R Hafferty
- Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington
| | - Tess M Cullaz
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | | | - Pooja S Tandon
- Pediatrics
- Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington
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Exploring Equity in Healthcare Services: Spatial Accessibility Changes during Subway Expansion. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2021. [DOI: 10.3390/ijgi10070439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The unequal allocation of healthcare resources raises many fundamental problems, one of which is how to address inequity in population health. This paper focuses on disparities in public transport healthcare accessibility, with a special focus on an expanding subway system. Based on a vulnerability index, including factors that are likely to limit healthcare opportunities, a two-step floating catchment area method was used to assess the distribution of supply and demand for healthcare. Quantity, quality, and walking distance accessibility were aggregated into hexagonal grids. The Theil index was used to measure inequity and understand the influence of subways on spatial disparities in healthcare accessibility. The ongoing construction of the subway has heterogeneous impacts on healthcare accessibility for different parts of the city and exacerbates spatial inequity in many areas. In an environment where people in peri-urban areas are excluded from healthcare access because of low subway coverage, the results suggest that the potential for subways to address inaccessibility is limited. The findings highlight the requirement of efficient public transport services and are relevant to researchers, planners, and policymakers aiming to improve accessibility to healthcare, especially for populations who dwell in winter cities.
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Saghapour T, Giles-Corti B, Rachele J, Turrell G. A cross-sectional and longitudinal study of neighbourhood disadvantage and cardiovascular disease and the mediating role of physical activity. Prev Med 2021; 147:106506. [PMID: 33677028 DOI: 10.1016/j.ypmed.2021.106506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 01/21/2021] [Accepted: 02/27/2021] [Indexed: 12/17/2022]
Abstract
We investigate the prospective association between neighbourhood-level disadvantage and cardiovascular disease (CVD) among mid-to-older aged adults and whether physical activity (PA) mediates this association. The data come from the HABITAT project, a multilevel longitudinal investigation of health and wellbeing in Brisbane. The participants were 11,035 residents of 200 neighbourhoods in 2007, with follow-up data collected in 2009, 2011, 2013 and 2016. Multilevel binomial regression was used for the cross-sectional analysis and mixed-effect parametric survival models were used for the longitudinal analysis. Models were adjusted for age, sex, education, occupation, and household income. Those with pre-existing CVD at baseline were excluded from the longitudinal analyses. The mediated effect of PA on CVD was examined using multilevel generalized structural equation modelling. There was a total of 20,064 person-year observations across the five time-points clustered at three levels. Results indicated that the incidence of CVD was significantly higher in the most disadvantaged neighbourhoods (OR 1.50; HR 1.29) compared with the least disadvantaged. Mediation analysis results revealed that 11.5% of the effect of neighbourhood disadvantage on CVD occurs indirectly through PA in the most disadvantaged neighbourhoods while the corresponding figure is 5.2% in the more advantaged areas. Key findings showed that neighbourhood disadvantage is associated with the incidence of CVD, and PA is a significant mediator of this relationship. Future research should investigate which specific social and built environment features promote or inhibit PA in disadvantaged areas as the basis for policy initiatives to address inequities in CVD.
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Affiliation(s)
- Tayebeh Saghapour
- Centre for Urban Research, College of Design and Social Context, RMIT University, Australia.
| | - Billie Giles-Corti
- Centre for Urban Research, College of Design and Social Context, RMIT University, Australia
| | - Jerome Rachele
- Melbourne School of Population and Global Health, The University of Melbourne, Australia; College of Health and Biomedicine, Victoria University, Australia
| | - Gavin Turrell
- Centre for Urban Research, College of Design and Social Context, RMIT University, Australia; Centre for Research and Action in Public Health, Health Research Institute, University of Canberra, Australia
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12
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Otero Peña JE, Kodali H, Ferris E, Wyka K, Low S, Evenson KR, Dorn JM, Thorpe LE, Huang TTK. The Role of the Physical and Social Environment in Observed and Self-Reported Park Use in Low-Income Neighborhoods in New York City. Front Public Health 2021; 9:656988. [PMID: 33959584 PMCID: PMC8095666 DOI: 10.3389/fpubh.2021.656988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/19/2021] [Indexed: 11/26/2022] Open
Abstract
Physical and social environments of parks and neighborhoods influence park use, but the extent of their relative influence remains unclear. This cross-sectional study examined the relationship between the physical and social environment of parks and both observed and self-reported park use in low-income neighborhoods in New York City. We conducted community- (n = 54 parks) and individual-level (n = 904 residents) analyses. At the community level, observed park use was measured using a validated park audit tool and regressed on the number of facilities and programmed activities in parks, violent crime, stop-and-frisk incidents, and traffic accidents. At the individual level, self-reported park use was regressed on perceived park quality, crime, traffic-related walkability, park use by others, and social cohesion and trust. Data were collected in 2016–2018 and analyzed in 2019–2020. At the community level, observed park use was negatively associated with stop-and-frisk (β = −0.04; SE = 0.02; p < 0.05) and positively associated with the number of park facilities (β = 1.46; SE = 0.57; p < 0.05) and events (β = 0.16; SE = 0.16; p < 0.01). At the individual level, self-reported park use was positively associated with the social cohesion and trust scale (β = 0.02; SE = 0.01; p < 0.05). These results indicate that physical and social attributes of parks, but not perceptions of parks, were significantly associated with park use. The social environment of neighborhoods at both community and individual levels was significantly related to park use. Policies for increasing park use should focus on improving the social environment of parks and surrounding communities, not only parks' physical attributes. These findings can inform urban planning and public health interventions aimed at improving the well-being of residents in low-income communities.
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Affiliation(s)
- Javier E Otero Peña
- Department of Psychology, The Graduate Center, City University of New York, New York, NY, United States.,Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Hanish Kodali
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Emily Ferris
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Katarzyna Wyka
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Setha Low
- Department of Psychology, The Graduate Center, City University of New York, New York, NY, United States
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Joan M Dorn
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, United States
| | - Lorna E Thorpe
- Department of Population Health, School of Medicine, New York University, New York, NY, United States
| | - Terry T K Huang
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
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13
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Padial-Ruz R, Puga-González ME, Céspedes-Jiménez Á, Cabello-Manrique D. Determining Factors in the Use of Urban Parks That Influence the Practice of Physical Activity in Children: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073648. [PMID: 33807466 PMCID: PMC8037159 DOI: 10.3390/ijerph18073648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 01/16/2023]
Abstract
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.
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Affiliation(s)
- Rosario Padial-Ruz
- Department of Didactics of Musical, Plastic and Corporal, University of Granada, 18011 Granada, Spain;
| | - Mª Esther Puga-González
- Department of Didactics of Musical, Plastic and Corporal, University of Granada, 18011 Granada, Spain;
- Correspondence: ; Tel.: +34-6075-875-23
| | - Álvaro Céspedes-Jiménez
- Department of Physical Education and Sports, University of Granada, 18011 Granada, Spain; (Á.C.-J.); (D.C.-M.)
| | - David Cabello-Manrique
- Department of Physical Education and Sports, University of Granada, 18011 Granada, Spain; (Á.C.-J.); (D.C.-M.)
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14
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Tcymbal A, Demetriou Y, Kelso A, Wolbring L, Wunsch K, Wäsche H, Woll A, Reimers AK. Effects of the built environment on physical activity: a systematic review of longitudinal studies taking sex/gender into account. Environ Health Prev Med 2020; 25:75. [PMID: 33246405 PMCID: PMC7697377 DOI: 10.1186/s12199-020-00915-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/09/2020] [Indexed: 12/01/2022] Open
Abstract
Background Individual health behavior is related to environmental and social structures. To promote physical activity (PA) effectively, it is necessary to consider structural influences. Previous research has shown the relevance of the built environment. However, sex/gender differences have yet not been considered. The aim of this systematic review was to identify built environmental determinants of PA by taking sex/gender into account. Methods A systematic literature search was carried out using six electronic databases (PubMed, CINAHL, SportDiscus, PsycInfo, Scopus, Web of Knowledge) to identify studies analyzing the effect of changes in the built environment on PA, taking sex/gender into account. To be included, studies had to be based on quantitative data and a longitudinal study design. Changes in the built environment had to be objectively assessed. The methodological quality of the studies was examined using the QualSyst tool for examining risk of bias. Results In total, 36 studies published since 2000 were included in this review. The data synthesis revealed that the majority of reviewed studies found the built environment to be a determinant of PA behavior for both, males and females, in a similar way. Creating a new infrastructure for walking, cycling, and public transportation showed a positive effect on PA behavior. Findings were most consistent for the availability of public transport, which was positively associated with overall PA and walking. The improvement of walking and cycling infrastructure had no effect on the overall level of PA, but it attracted more users and had a positive effect on active transportation. In women, the availability of public transport, safe cycling lanes, housing density, and the distance to daily destinations proved to be more relevant with regard to their PA behavior. In men, street network characteristics and road environment, such as intersection connectivity, local road density, and the presence of dead-end roads, were more important determinants of PA. Conclusion This review sheds light on the relevance of the built environment on PA. By focusing on sex/gender differences, a new aspect was addressed that should be further analyzed in future research and considered by urban planners and other practitioners.
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Affiliation(s)
- Antonina Tcymbal
- Department of Sport Science and Sport, Friedrich-Alexander-University University Erlangen-Nuremberg, Gebbertstraße 123b, 91058, Erlangen, Germany.
| | - Yolanda Demetriou
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Anne Kelso
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Laura Wolbring
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Kathrin Wunsch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Hagen Wäsche
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Anne K Reimers
- Department of Sport Science and Sport, Friedrich-Alexander-University University Erlangen-Nuremberg, Gebbertstraße 123b, 91058, Erlangen, Germany
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15
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Using natural experiments to improve public health evidence: a review of context and utility for obesity prevention. Health Res Policy Syst 2020; 18:48. [PMID: 32423438 PMCID: PMC7236508 DOI: 10.1186/s12961-020-00564-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/13/2020] [Indexed: 02/02/2023] Open
Abstract
Background Natural experiments are increasingly valued as a way to assess the health impact of health and non-health interventions when planned controlled experimental research designs may be infeasible or inappropriate to implement. This study sought to investigate the value of natural experiments by exploring how they have been used in practice. The study focused on obesity prevention research as one complex programme area for applying natural experiment studies. Methods A literature search sought obesity prevention research from January 1997 to December 2017 and identified 46 population health studies that self-described as a natural experiment. Results The majority of studies identified were published in the last 5 years, illustrating a more recent adoption of such opportunities. The majority of studies were evaluations of the impact of policies (n = 19), such as assessing changes to food labelling, food advertising or taxation on diet and obesity outcomes, or were built environment interventions (n = 17), such as the impact of built infrastructure on physical activity or access to healthy food. Research designs included quasi-experimental, pre-experimental and non-experimental methods. Few studies applied rigorous research designs to establish stronger causal inference, such as multiple pre/post measures, time series designs or comparison of change against an unexposed group. In general, researchers employed techniques to enhance the study utility but often were limited in the use of more rigorous study designs by ethical considerations and/or the particular context of the intervention. Conclusion Greater recognition of the utility and versatility of natural experiments in generating evidence for complex health issues like obesity prevention is needed. This review suggests that natural experiments may be underutilised as an approach for providing evidence of the effects of interventions, particularly for evaluating health outcomes of interventions when unexpected opportunities to gather evidence arise.
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16
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Huang JH, Hipp JA, Marquet O, Alberico C, Fry D, Mazak E, Lovasi GS, Robinson WR, Floyd MF. Neighborhood characteristics associated with park use and park-based physical activity among children in low-income diverse neighborhoods in New York City. Prev Med 2020; 131:105948. [PMID: 31836479 DOI: 10.1016/j.ypmed.2019.105948] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 11/22/2019] [Accepted: 11/30/2019] [Indexed: 01/01/2023]
Abstract
Urban parks provide spaces and facilities for children's physical activity (PA) and can be a free resource in low-income communities. This study examined whether neighborhood characteristics were associated with children's park use and park-based moderate-to-vigorous PA (MVPA) in low-income diverse communities and how associations differed between ethnic groups. Data on park visits and MVPA came from 16,402 children 5-10-years old directly observed using the System for Observing Play and Recreation in Communities in 20 parks in low-income neighborhoods with majority Latino or Asian populations in New York City. Neighborhood characteristics included land use mix (LUM), street audits, crime rates, and an area deprivation index. We employed Poisson and negative binomial models to estimate effects of neighborhood-level variables on the number of children observed in parks and engaging in MVPA, overall and by ethnicity. Results for Asian, Latino, and African American children indicated that higher levels of LUM and pedestrian-friendly streets were associated with greater numbers of children in parks and higher MVPA across all three groups. For Asian and Latino children only, quality of environment was positively associated with MVPA, whereas level of deprivation and crime rates in the surrounding neighborhood were negatively associated with children's park-based MVPA. In contrast, a park's access to public transportation was negatively associated with number of all children observed and engaging in MVPA. Study findings suggest that park-based MVPA interventions can be informed by understanding how neighborhood characteristics facilitate and constrain park use and park-based MVPA.
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Affiliation(s)
- Jing-Huei Huang
- Department of Parks, Recreation, and Tourism Management, NC State University, NC, USA; Center for Geospatial Analytics, NC State University, Raleigh, NC, USA
| | - J Aaron Hipp
- Department of Parks, Recreation, and Tourism Management, NC State University, NC, USA; Center for Geospatial Analytics, NC State University, Raleigh, NC, USA.
| | - Oriol Marquet
- Department of Parks, Recreation, and Tourism Management, NC State University, NC, USA; Center for Geospatial Analytics, NC State University, Raleigh, NC, USA; Department of Geography, Universitat Autònoma de Barcelona, Spain
| | - Claudia Alberico
- Department of Parks, Recreation, and Tourism Management, NC State University, NC, USA; Center for Geospatial Analytics, NC State University, Raleigh, NC, USA
| | - Dustin Fry
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Elizabeth Mazak
- Department of Parks, Recreation, and Tourism Management, NC State University, NC, USA; Center for Geospatial Analytics, NC State University, Raleigh, NC, USA
| | - Gina S Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Whitney R Robinson
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Myron F Floyd
- Department of Parks, Recreation, and Tourism Management, NC State University, NC, USA
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17
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Marquet O, Hipp JA, Alberico C, Huang JH, Fry D, Mazak E, Lovasi GS, Floyd MF. Use of SOPARC to assess physical activity in parks: do race/ethnicity, contextual conditions, and settings of the target area, affect reliability? BMC Public Health 2019; 19:1730. [PMID: 31870351 PMCID: PMC6929368 DOI: 10.1186/s12889-019-8107-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/18/2019] [Indexed: 11/20/2022] Open
Abstract
Background Since its introduction in 2006, SOPARC (Systematic Observation of Play and Recreation in Communities) has become a fundamental tool to quantify park visitor behaviors and characteristics. We tested SOPARC reliability when assessing race/ethnicity, physical activity, contextual conditions at the time of observation, and settings of target areas to understand its utility when trying to account for individual characteristics of users. Methods We used 4725 SOPARC observations completed simultaneously by two independent observers to evaluate intraclass correlation and agreement rate between the two observers when trying to assess sex, age group, race/ethnicity, and level of physical activity of urban park users in different park settings. Observations were in 20 New York City parks during Spring and Summer 2017 within the PARC3 project. Results Observers counted 25,765 park users with high interobserver reliability (ICC = .94; %Agreement.75). Reliability scores were negatively affected by the population being observed, the intensity of physical activity, and the contextual conditions and settings of the target area at the time of observation. Specific challenges emerged when assessing the combination of physical activity and race/ethnicity. Conclusions SOPARC training should aim to improve reliability when assessing concurrent measures such as physical activity, race/ethnicity, age, and sex. Similarly, observing crowded park areas with many active users areas may require more observation practice hours.
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Affiliation(s)
- Oriol Marquet
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain.
| | - J Aaron Hipp
- Department of Parks, Recreation, and Tourism Management, NC State University, Raleigh, NC, USA.,Center for Geospatial Analytics, NC State University, Raleigh, NC, USA
| | - Claudia Alberico
- Department of Parks, Recreation, and Tourism Management, NC State University, Raleigh, NC, USA.,Center for Geospatial Analytics, NC State University, Raleigh, NC, USA
| | - Jing-Huei Huang
- Department of Parks, Recreation, and Tourism Management, NC State University, Raleigh, NC, USA.,Center for Geospatial Analytics, NC State University, Raleigh, NC, USA
| | - Dustin Fry
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Elizabeth Mazak
- Department of Parks, Recreation, and Tourism Management, NC State University, Raleigh, NC, USA.,Center for Geospatial Analytics, NC State University, Raleigh, NC, USA
| | - Gina S Lovasi
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Myron F Floyd
- Department of Parks, Recreation, and Tourism Management, NC State University, Raleigh, NC, USA
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18
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McKenzie TL. Context Matters: Systematic Observation of Place-Based Physical Activity. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2016; 87:334-341. [PMID: 27749158 DOI: 10.1080/02701367.2016.1234302] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Physical activity is place-based, and being able to assess the number of people and their characteristics in specific locations is important both for public health surveillance and for practitioners in their design of physical activity spaces and programs. Although physical activity measurement has improved recently, many investigators avoid or are at a loss regarding the assessment of physical activity in explicit locations, especially in open environments where many people come and go in a seemingly indiscriminate fashion. Direct, systematic observation exceeds other methods in simultaneously assessing physical activity and the contexts in which it occurs. This commentary summarizes the development and use of 2 validated observation tools: the System for Observing Play and Leisure in Youth (SOPLAY) and System for Observing Play and Active Recreation in Communities (SOPARC). Their use is well supported by both behavior-analytic principles and social-ecological theory, and their methods have utility for both researchers and practitioners.
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