The impact of the built environment on health behaviours and disease transmission in social systems

Hierarchically embedded scales of movement shape the social networks of vampire bats

Social structure can emerge from hierarchically embedded scales of movement, where movement at one scale is constrained within a larger scale (e.g. among branches, trees, forests). In most studies of animal social networks, some scales of movement are not observed, and the relative importance of the observed scales of movement is unclear. Here, we asked: how does individual variation in movement, at multiple nested spatial scales, influence each individual's social connectedness? Using existing data from common vampire bats (Desmodus rotundus), we created an agent-based model of how three nested scales of movement-among roosts, clusters and grooming partners-each influence a bat's grooming network centrality. In each of 10 simulations, virtual bats lacking social and spatial preferences moved at each scale at empirically derived rates that were either fixed or individually variable and either independent or correlated across scales. We found that numbers of partners groomed per bat were driven more by within-roost movements than by roost switching, highlighting that co-roosting networks do not fully capture bat social structure. Simulations revealed how individual variation in movement at nested spatial scales can cause false discovery and misidentification of preferred social relationships. Our model provides several insights into how nonsocial factors shape social networks.

Influences of healthcare workers' behaviours towards infection prevention and control practices in the clinical setting: A systematic review

AIM

To systematically evaluate empirical studies investigating the influences of healthcare workers' behaviours towards infection prevention and control practices in the Coronavirus clinical space, and to appraise and synthesise these findings.

DESIGN

A systematic review of the literature.

METHODS

The review used a five-step framework described by Khan et al. (Journal of the Royal Society of Medicine, 2003, 96 and 118) of Framing questions for a review; Identifying relevant work; Assessing the quality of studies; Summarising the evidence; and Interpreting the findings. Searches were conducted in CINHAL, MEDLINE, PsychINFO, Scopus, and Google Scholar databases to retrieve relevant peer-reviewed literature published in English between 2019 and 2023. Covidence and Joanna Briggs Quality appraisal tools were used for critical assessment. To improve transparent reporting, this review used a Synthesis Without Meta-analysis (SWiM) in systematic review guidelines, as informed by Campbell et al. (BMJ, 2020, 368).

RESULTS

Twenty studies were included in this review, identifying nine themes describing factors influencing HCWs' behaviours towards IPC practices in the coronavirus environment. The overarching influences emerged as knowledge-oriented, person-oriented, and environment-oriented.

CONCLUSION

Healthcare workers' responsibilities at point-of-care involve providing direct care to patients with highly transmissible infections and working in clinical settings that may be ill-designed for IPC practices, increasing the risk of transmission. Given the lack of a definitive solution to eradicate new mutant viruses and that IPC practices are the mainstay of prevention and control of transmissible, measures to improve are imperative. The identified HCWs' domains on behaviours towards IPC are critical in strategies to mitigate risks and further set an opportunity for developing an IPC model congruent with the rapid response required for HCWs during emerging or re-merging mutant virus outbreaks. This is significant, given that HCWs' preparedness with IPC practices at point-of-care is central to patient care, the workforce and community safety.

Effect of the Built Environment on the Cumulative Incidence of Acute Diarrheal Diseases: A Community-Based Cohort Study From Underprivileged Areas of Bhopal, India

Background Diarrhea is a major public health problem in under-five children worldwide. Various sociodemographic, environmental, and behavioral factors play a role in the occurrence of diarrheal disease in children under the age of five. This study aims to estimate the cumulative incidence of acute diarrheal diseases during a one-year study period and examine its association with the built environment factors among children under the age of five in selected underprivileged areas of Bhopal. Methodology We conducted this study in Bhopal, a city in central India. We surveyed the underprivileged dwellers of Vajpayee Nagar, Sanjay Nagar, and Mother India Colony of Bhopal city. This is a prospective cohort study with a one-year follow-up period to examine the cumulative incidence of acute diarrheal diseases among under-five-year-old children in the study area. Data were analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results Data were collected from February 2021 to February 2022. A total of 658 families of eligible children were contacted to participate in the study. After excluding 38 participants for various reasons (denied consent: 3; lost to follow-up: 32; moved out of the study area: 3), data were finally analyzed for 620 participants. In the study among the under-five-year-old children, the cumulative incidence of acute diarrheal diseases was 23.8% (148 out of 620). In our study, lower age (adjusted odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.75-0.99, p = 0.041) and non-availability of flush latrine in the house (adjusted OR = 4.95, 95% CI = 1.80-13.59, p = 0.002) were statistically associated with a higher incidence of acute diarrheal disease among the study population. Conclusions In our investigation, we observed a cumulative incidence of diarrhea at 23.8% (148 out of 620) among the underprivileged under-five population residing in Bhopal, India. This incidence exhibited significant associations with younger age and the absence of in-house flush latrines.

Untapped Potential of Unobtrusive Observation for Studying Health Behaviors

Improving the environment is an important upstream intervention to promote population health by influencing health behaviors such as physical activity, smoking, and social distancing. Examples of promising environmental interventions include creating high-quality green spaces, building active transport infrastructure, and implementing urban planning regulations. However, there is little robust evidence to inform policy and decision makers about what kinds of environmental interventions are effective and for which populations. In this viewpoint, we make the case that this evidence gap exists partly because health behavior research is dominated by obtrusive methods that focus on studying individual behavior and that are less suitable for understanding environmental influences. In contrast, unobtrusive observation can assess how behavior varies in different environmental contexts. It thereby provides valuable data relating to how environments affect the behavior of populations, which is often useful knowledge for effectively and equitably tackling population health challenges such as obesity and noncommunicable diseases. Yet despite a long history, unobtrusive observation methods are currently underused in health behavior research. We discuss how developing the use of video technology and automated computer vision techniques can offer a scalable solution for assessing health behaviors, facilitating a more thorough investigation of how environments influence health behaviors. We also reflect on the important ethical challenges associated with unobtrusive observation and the use of these emerging video technologies. By increasing the use of unobtrusive observation alongside other methods, we strongly believe this will improve our understanding of the influences of the environment on health behaviors.

Identifying spatial heterogeneity of COVID-19 transmission clusters and their built-environment features at the neighbourhood scale

The identification of high-risk areas for infectious disease transmission and its built-environment features are crucial for targeted surveillance and early prevention efforts. While previous research has explored the association between infectious disease incidence and urban built environment, the investigation of spatial heterogeneity of built-environment features in high-risk areas has been insufficient. This paper aims to address this gap by analysing the spatial heterogeneity of COVID-19 clusters in Shanghai at the neighbourhood scale and examining associated built-environment features. Using a spatiotemporal clustering algorithm, the study analysed 1395 reported cases in Shanghai from March 6 to March 17, 2022. Both global Poisson regression (GPR) and geographically weighted Poisson regression (GWPR) models were applied to examine the association between built-environment variables and the size of COVID-19 clusters. Our findings suggest that larger COVID-19 clusters emerging in the suburbs compared with the downtown and multiple built-environment features are significantly associated with this pattern. Specifically, neighbourhoods with a higher proportion of commercial, public service and industrial land, higher centrality of metro stations, and proximity to hospitals are positively associated with larger COVID-19 clusters, while neighbourhoods with higher land use mix and green/open spaces density are associated with smaller COVID-19 clusters. Moreover, we identified that metro stations with high centrality present the highest risk in the downtown, while commercial and public service places exhibit the highest risk in the suburbs. By highlighting the overlooked spatial heterogeneity of built-environment features for high-risk areas, this study aims to provide valuable guidance for public health departments in implementing place-based interventions to effectively prevent the spread of potential epidemics.

Self-regulation of effort for a better health-related quality of life: a multidimensional activity pacing model for chronic pain and fatigue management

PURPOSE

To propose a comprehensive multidimensional model of activity pacing that improves health-related quality of life and promotes sustained physical activity engagement among adults with chronic conditions.

MATERIALS AND METHODS

A narrative review was conducted to examine the existing literature on activity pacing, health-related quality of life, pain and fatigue management, and physical activity promotion in chronic conditions.

RESULTS

The literature revealed a lack of a cohesive approach towards a multidimensional model for using activity pacing to improve health-related quality of life. A comprehensive multidimensional model of activity pacing was proposed, emphasizing the importance of considering all aspects of pacing for sustained physical activity engagement and improved health-related quality of life. The model incorporates elements such as rest breaks, self-regulatory skills, environmental factors, and effective coping strategies for depression/anxiety. It takes into account physical, psychological, and environmental factors, all of which contribute significantly to the enhancement of health-related quality of life, physical function, and overall well-being, reflecting a holistic approach.

CONCLUSIONS

The model offers guidance to researchers and clinicians in effectively educating patients on activity pacing acquisition and in developing effective interventions to enhance physical activity engagement and health outcomes among adults with chronic conditions. Additionally, it serves as a tool towards facilitating discussions on sustained physical activity and a healthy lifestyle for patients, which can eventually lead to improved quality of life.

Architectural experience influences the processing of others' body expressions

The interplay between space and cognition is a crucial issue in Neuroscience leading to the development of multiple research fields. However, the relationship between architectural space and the movement of the inhabitants and their interactions has been too often neglected, failing to provide a unifying view of architecture's capacity to modulate social cognition broadly. We bridge this gap by requesting participants to judge avatars' emotional expression (high vs. low arousal) at the end of their promenade inside high- or low-arousing architectures. Stimuli were presented in virtual reality to ensure a dynamic, naturalistic experience. High-density electroencephalography (EEG) was recorded to assess the neural responses to the avatar's presentation. Observing highly aroused avatars increased Late Positive Potentials (LPP), in line with previous evidence. Strikingly, 250 ms before the occurrence of the LPP, P200 amplitude increased due to the experience of low-arousing architectures, reflecting an early greater attention during the processing of body expressions. In addition, participants stared longer at the avatar's head and judged the observed posture as more arousing. Source localization highlighted a contribution of the dorsal premotor cortex to both P200 and LPP. In conclusion, the immersive and dynamic architectural experience modulates human social cognition. In addition, the motor system plays a role in processing architecture and body expressions suggesting that the space and social cognition interplay is rooted in overlapping neural substrates. This study demonstrates that the manipulation of mere architectural space is sufficient to influence human social cognition.

An Overview of How the Built Environment Relates to Children's Health

PURPOSE OF REVIEW

Explore the varied pathways between the built environment and children's health. The review begins by describing how the built environment and transport infrastructure relate to conditions that lead to health outcomes. The review examines emissions, noise, and traffic dangers in relation to children's physical, mental, and social health.

RECENT FINDINGS

Evidence is increasing for walkable neighborhoods and health-related behavior such as physical activity. However, diverse land uses (often supporting walkability) were also found to increase traffic injuries. Cognitive impacts of motorways on children at schools were found. Finally, the relationships between social activities and built environment are beginning. The built environment's influence on various physical health outcomes is increasingly clear and is often through a transport pathway. However, the links with mental and social health are less developed, though recent findings show significant results. Having accessible child-relevant destinations is an important consideration for children's health.

Association Between Daily Internet Use and Incidence of Chronic Diseases Among Older Adults: Prospective Cohort Study

BACKGROUND

Chronic disease incidence among the elderly is increasing, which is correlated with the acceleration of population aging. Evolving internet technologies may help prevent and provide interventions for chronic diseases in an accelerating aging process. However, the impact of daily internet use on the incidence of chronic diseases is not well understood.

OBJECTIVE

This study aims to investigate whether daily internet use by middle-aged and older adults may inhibit or promote the occurrence of chronic diseases.

METHODS

We included participants from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal survey of Chinese residents aged ≥45 years. We assessed 8-year data from wave 1 (June 2011-March 2012) to wave 4 (July-September 2018) in CHARLS. Data from wave 4 were used for a cross-sectional study, and data from all 4 waves were used for a longitudinal study. Self-reported data were used to track variables, including internet use, use frequency, and the incidence of different chronic diseases. Cox proportional hazards modeling was applied in the longitudinal study to examine the relationship between daily internet use and chronic diseases among middle-aged and older adults, while adjusting for sociodemographic characteristics and health behaviors. In addition, longitudinal data were used to analyze internet usage trends, and cross-sectional data were used to analyze the factors influencing internet use.

RESULTS

Among the 20,113 participants included in the longitudinal analyses, internet use increased significantly, from 2% to 12.3%, between 2011 and 2018. The adjusted model found statistically significant relationships between daily internet use and a lower incidence of the following chronic diseases: hypertension (hazard ratio [HR] 0.78, 95% CI 0.65-0.95, P=.01), chronic lung disease (HR 0.74, 95% CI 0.57-0.97, P=.03), stroke (HR 0.69, 95% CI 0.50-0.94, P=.02), digestive disease (HR 0.73, 95% CI 0.58-0.91, P=.005), memory-related disorders (HR 0.58, 95% CI 0.37-0.91, P=.02), arthritis or rheumatism (HR 0.60, 95% CI 0.48-0.76, P<.001), asthma (HR 0.52, 95% CI 0.33-0.84, P=.007), depression (HR 0.80, 95% CI 0.71-0.89, P<.001), and vision impairment (HR 0.83, 95% CI 0.74-0.93, P=.004). Moreover, our study also showed that with increasing frequency of internet use, the risk of some chronic diseases decreases.

CONCLUSIONS

This study found that middle-aged and older adults who use the internet have a reduced risk of developing chronic diseases versus those who do not use the internet. The increasing prevalence of daily internet use among middle-aged and older adults may stimulate contemplation of the potential role of internet platforms in future research on chronic disease prevention.

Impact of social and demographic factors on the spread of the SARS-CoV-2 epidemic in the town of Nice

INTRODUCTION

Socio-demographic factors are known to influence epidemic dynamics. The town of Nice, France, displays major socio-economic inequalities, according to the National Institute of Statistics and Economic Studies (INSEE), 10% of the population is considered to live below the poverty threshold, i.e. 60% of the median standard of living.

OBJECTIVE

To identify socio-economic factors related to the incidence of SARS-CoV-2 in Nice, France.

METHODS

The study included residents of Nice with a first positive SARS-CoV-2 test (January 4-February 14, 2021). Laboratory data were provided by the National information system for Coronavirus Disease (COVID-19) screening (SIDEP) and socio-economic data were obtained from INSEE. Each case's address was allocated to a census block to which we assigned a social deprivation index (French Deprivation index, FDep) divided into 5 categories. For each category, we computed the incidence rate per age and per week and its mean weekly variation. A standardized incidence ratio (SIR) was calculated to investigate a potential excess of cases in the most deprived population category (FDep5), compared to the other categories. Pearson's correlation coefficient was computed and a Generalized Linear Model (GLM) applied to analyse the number of cases and socio-economic variables per census blocks.

RESULTS

We included 10,078 cases. The highest incidence rate was observed in the most socially deprived category (4001/100,000 inhabitants vs 2782/100,000 inhabitants for the other categories of FDep). The number of observed cases in the most social deprivated category (FDep5: N = 2019) was significantly higher than in the others (N = 1384); SIR = 1.46 [95% CI:1.40-1.52; p < 0.001]. Socio-economic variables related to poor housing, harsh working conditions and low income were correlated with the new cases of SARS-CoV-2.

CONCLUSION

Social deprivation was correlated with a higher incidence of SARS-CoV-2 during the 2021 epidemic in Nice. Local surveillance of epidemics provides complementary data to national and regional surveillance. Mapping socio-economic vulnerability indicators at the census block level and correlating these with incidence could prove highly useful to guide political decisions in public health.

Spatial variations of the third and fourth COVID-19 waves in Hong Kong: A comparative study using built environment and socio-demographic characteristics

Since the first confirmed case was reported in January 2020, Hong Kong has experienced multiple waves of COVID-19 outbreaks. Recent literature has explored the spatial patterns of disease incidence and their relationships with the built environment and demographic characteristics. Nonetheless, few studies aim at the comparative patterns of different epidemic waves occurring in the same spatial context. This study analyses spatial patterns of the third and fourth COVID-19 epidemic waves and then evaluates the spatial relationship between case incidence and built environment and socio-demographic characteristics. By collecting local-related cases, this study incorporates a two-fold analytical strategy: (1) Using rank-size distribution and log-odd ratio to depict the spatial pattern of COVID-19 incidence rates; (2) through global and local regression models, investigating incidence's associations with the urban built environment and socio-demographic characteristics. The results reveal that the two different epidemic waves have far distinct spatial tendencies to their infection risk factors, reflecting location-specific associations with the built environments and socio-demographics. Collectively, we discover that the third and fourth COVID-19 waves are likely associated with residential context and urban activities, respectively. Practical implications are discussed that would be of interest to policymakers and health professionals.

Does the quality of street greenspace matter? Examining the associations between multiple greenspace exposures and chronic health conditions of urban residents in a rapidly urbanising Chinese city

BACKGROUND

Numerous studies have demonstrated that greenspace(GS) exposure is associated with health improvements in individuals with hypertension and diabetes. However, studies examining the associations between multiple GS exposures and chronic health conditions in developing countries are limited.

METHODS

Geospatial data and spatial analysis were employed to objectively measure the total neighbourhood vegetative cover (mean value of normalised difference vegetation index [NDVI] within specific buffer zone) and proximity to park-based GS (network distance from home to the entrance of park-based GS). Street view imagery and machine learning techniques were used to measure the subjective perceptions of street GS quality. A multiple linear regression model was applied to examine the associations between multiple GS exposures and the prevalence of hypertension and diabetes in neighbourhoods located in Qingdao, China.

RESULTS

The model explained 29.8% and 28.2% of the prevalence of hypertension and diabetes, respectively. The results suggested that: 1) the total vegetative cover of the neighbourhood was inversely correlated with the prevalence of hypertension (β = -0.272, p = 0.013, 95% confidence interval (CI): [-1.332, -0.162]) and diabetes (β = -0.230, p = 0.037, 95% CI: [-0.720, -0.008]). 2) The street GS quality was negatively correlated with the prevalence of hypertension (β = -0.303, p = 0.007, 95% CI: [-2.981, -0.491]) and diabetes (β = -0.309, p = 0.006, 95% CI: [-1.839, -0.314]). 3) Proximity to park-based GS and the prevalence of hypertension and diabetes mellitus were not significantly correlated.

CONCLUSIONS

This study used subjective and objective methods to comprehensively assess the greenspace exposure from overhead to eye level, from quantity, proximity to quality. The results demonstrated the beneficial relationships between street GS quality, total vegetative cover, and chronic health in a rapidly urbanising Chinese city. Furthermore. the effect of street GS quality was more pronounced in potentially mitigating chronic health problems, and improving the quality of street GS might be an efficient and effective intervention pathway for addressing chronic health issues in densely populated cities.

Perspectives on barriers and facilitators to lifestyle change after cardiac events among patients in Saudi Arabia: a qualitative study

AIMS

Lifestyle interventions are an essential element in the prevention of cardiovascular disease. However, promoting a healthy lifestyle is challenging because a multitude of factors interact and influence people's decisions to adopt and maintain healthy lifestyles. The effects of these factors on Saudi cardiac patients are largely unknown. This study aimed to explore the barriers and facilitators to healthy lifestyle changes among Saudis after cardiac events.

METHODS AND RESULTS

The study followed an exploratory qualitative research design, using a social ecological approach. Semi-structured interviews were conducted with 21 participants (13 men and 8 women) who had a cardiac event. Participants were purposively recruited from cardiac clinics of two hospitals in Jeddah, Saudi Arabia. Data were analysed using the qualitative framework analysis, and factors were identified as salient based on their frequency and the potential strength of their impact. Six factors were identified as influencing lifestyle behaviours in cardiac patients, categorized as 'major' factors and 'mediating' factors. The 'major' factors were sociocultural norms, family values, and religious beliefs, and the mediating factors were insufficient healthcare services, physical environment, and policy regulations. Depending upon the behaviours reported and the context, the same factor could be classified as both a barrier and a facilitator.

CONCLUSION

The findings of this study can be used to inform the development of contextual-based interventions to promote the adoption of healthy lifestyles that meet the population needs and are relevant to Saudi society.

Behavioural ecology at the spatial-social interface

Spatial and social behaviour are fundamental aspects of an animal's biology, and their social and spatial environments are indelibly linked through mutual causes and shared consequences. We define the 'spatial-social interface' as intersection of social and spatial aspects of individuals' phenotypes and environments. Behavioural variation at the spatial-social interface has implications for ecological and evolutionary processes including pathogen transmission, population dynamics, and the evolution of social systems. We link spatial and social processes through a foundation of shared theory, vocabulary, and methods. We provide examples and future directions for the integration of spatial and social behaviour and environments. We introduce key concepts and approaches that either implicitly or explicitly integrate social and spatial processes, for example, graph theory, density-dependent habitat selection, and niche specialization. Finally, we discuss how movement ecology helps link the spatial-social interface. Our review integrates social and spatial behavioural ecology and identifies testable hypotheses at the spatial-social interface.

The Association between Perceived Annoyances in the Indoor Home Environment and Respiratory Infections: A Danish Cohort Study with up to 19 Years of Follow-Up

The increasing prevalence of reported annoyances in the indoor environment threatens public health. This study aimed to investigate the association between perceived annoyances from the home environment and respiratory infections among individuals with and without asthma or chronic obstructive pulmonary disease (COPD). A total of 16,688 individuals from the Danish Health and Morbidity Survey initiated in 2000 were grouped according to their patterns of perceived annoyances. Information on respiratory infections (all causes, bacterial, viral, and those leading to hospital admissions) was obtained from Danish registers up to 19 years after the survey. Poisson regression of incidence rates (IRs) was applied to estimate incidence rate ratios (IRRs). Annoyances significantly increased the IR for respiratory infections of all causes and bacterial respiratory infections in individuals without asthma or COPD, adjusted IRR 1.16 (95% CI: 1.01, 1.34) and 1.15 (95% CI: 1.02, 1.31), respectively. However, no difference was observed for viral respiratory infections nor hospital admissions. Individuals with asthma or COPD and a high level of annoyances had a non-significantly increased IR in all four analyses of respiratory infections. These findings provide support for perceived annoyances as an important risk factor for respiratory infections.

Association of walkability and NO2 with metabolic syndrome: A cohort study in China

BACKGROUND

Epidemiological studies have reported an association between traffic-related pollution with risk of metabolic syndrome (MetS). However, evidence from prospective studies on the association of walkability and nitrogen dioxide (NO₂) with MetS is still scarce. We, therefore, aimed to evaluate the association of long-term exposure to NO₂ and walkability with hazards of incident MetS.

METHODS

A total of 17,965 participants without MetS diagnosed within one year at baseline were included in our study from a population-based prospective cohort in Yinzhou District, Ningbo, Zhejiang Province, China. Participants were followed up by the regional Health Information System (HIS) until December 15, 2021. MetS was defined based on the criteria of Chinese Diabetes Society (CDS2004). We used walkscore tools, calculating with amenity categories and decay functions, and spatial-temporal land-use regression (LUR) models to estimate walkability and NO₂ concentrations. We used Cox proportional hazards regression models to examine the association of walkability and NO₂ with hazards of MetS incidence reporting with hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Overall, we followed up 77,303 person-years and identified 4040 incident cases of MetS in the entire cohort. Higher walkability was inversely associated with incident MetS (HR = 0.94, 95 % CI: 0.91-0.99), whereas NO₂ was positively associated with MetS incidence (HR = 1.07, 95 %CI: 1.00-1.15) per interquartile range increment in two-exposure models. Furthermore, we found a significant multiplicative interaction between walkability and NO₂. Stronger associations were observed for NO₂ and incident MetS among men, smokers, drinkers and participants who aged < 60 years and had higher levels of income.

CONCLUSION

In summary, we found living in areas with lower walkability and higher concentrations of NO₂ were associated with increased incidence of MetS. The beneficial effect of higher walkability may be attenuated by exposure to NO₂.

Built environment color modulates autonomic and EEG indices of emotional response

Understanding built environment exposure as a component of environmental enrichment has significant implications for mental health, but little is known about the effects design characteristics have on our emotions and associated neurophysiology. Using a Cave Automatic Virtual Environment while monitoring indoor environmental quality (IEQ), 18 participants were exposed to a resting state (black), and two room scenes, control (white) and condition (blue), to understand if the color of the virtual walls affected self-report, autonomic nervous system, and central nervous system correlates of emotion. Our findings showed that exposure to the chromatic color condition (blue) compared to the achromatic control (white) and resting-state (black, no built environment) significantly increased the range in respiration and skin conductance response. We also detected a significant increase in alpha frontal midline power and frontal hemispheric lateralization relative to blue condition, and increased power spectral density across all electrodes in the blue condition for theta, alpha, and beta bandwidths. The ability for built environment design to modulate emotional response has the potential to deliver significant public health, economic, and social benefits to the entire community. The findings show that blue coloring of the built environment increases autonomic range and is associated with modulations of brain activity linked to emotional processing.

A standardized instrument quantifying risk factors associated with bi-directional transmission of SARS-CoV-2 and other zoonotic pathogens: The COVID-19 human-animal interactions survey (CHAIS)

Similar to many zoonotic pathogens which transmit from animals to humans, SARS-CoV-2 (CoV-2), the virus responsible for the COVID-19 pandemic, most likely originated in Rhinolophus bats before spreading among humans globally. Early into the pandemic, reports of CoV-2 diagnoses in animals from various countries emerged. While most CoV-2 positive animals were confirmed to have been in close contact with CoV-2 positive humans, there has been a paucity of published evidence to-date describing risk factors associated with CoV-2 transmission among humans and animals. The COVID-19 Human-Animal Interactions Survey (CHAIS) was developed to provide a standardized instrument describing human-animal interactions during the pandemic and to evaluate behavioral, spatiotemporal, and biological risk factors associated with bi-directional zoonotic transmission of CoV-2 within shared environments, predominantly households with limited information about human-wildlife or human-livestock interactions. CHAIS measures four broad domains of transmission risk: 1) risk and intensity of infection in human hosts, 2) spatial characteristics of shared environments, 3) behaviors and human-animal interactions, and 4) susceptible animal subpopulations. Following the development of CHAIS, with a One Health approach, a multidisciplinary group of experts (n = 20) was invited to review and provide feedback on the survey for content validity. Expert feedback was incorporated into two final survey formats—an extended version and an abridged version for which specific core questions addressing zoonotic and reverse zoonotic transmission were identified. Both versions are modularized, with each section having the capacity to serve as independent instruments, allowing researchers to customize the survey based on context and research-specific needs. Further adaptations for studies seeking to investigate other zoonotic pathogens with similar routes of transmission (i.e. respiratory, direct contact) are also possible. The CHAIS instrument is a standardized human-animal interaction survey developed to provide important data on risk factors that guide transmission of CoV-2, and other similar pathogens, among humans and animals.

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The CHAIS instrument is a standardized instrument evaluating risk factors for bi-directional CoV-2 zoonotic transmission

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It evaluates settings where humans and animals share close contact, mainly households

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It is highly adaptable for investigating other zoonotic pathogens such as influenza viruses

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It will enable pooling of data across studies for meta-analyses to improve predictive models

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It can help inform public health prevention and mitigation measures

Availability and affordability of alcohol and tobacco products for the population: results of a pilot study in the Sverdlovsk Oblast

Aim. To analyze the availability and affordability of alcohol and tobacco outlets using the specialized software developed by the National Medical Research Center for Therapy and Preventive Medicine in the pilot subject of the Russian Federation — the Sverdlovsk Oblast.

Material and methods. For the first time, experts from the National Medical Research Center for Therapy and Preventive Medicine conducted a pilot study to assess the actual state of the infrastructure of a separate subject of the Russian Federation (Sverdlovsk Oblast). The study objects were the urban infrastructure elements in which alcohol and tobacco products are sold. In order to assess the infrastructure, special software was developed using Open Street Maps to perform data collection tasks. The infrastructure data collection for the pilot study took place from January to March 2022.

Results. The total number of tobacco outlets is 299, most of which are located in supermarkets (82,6%, n=247). The share of individual tobacco outlets accounts for 13,7% (n=41). Out of 357 supermarkets, 247 (69%) have tobacco sales section. The average lowest price of a cigarette pack is 121,6±15,7 RUB (minimum — 30 RUB, maximum — 207 RUB). Twentyseven (10,9%) of 247 supermarkets located <100 m from educational institutions carry tobacco products. The minimum distance is 64 m. There are 449 alcohol outlets in total, most of them are located in supermarkets — 57,0% (n=256). Individual alcohol outlets account for 40,8% (n=183). Out of 357 supermarkets, 256 (71,7%) have alcohol sales section. Out of 158 individual alcohol outlets, vodka is available in 101 (63%) outlets, wine — in 112 (68,3%) out of 162 outlets, beer — in 112 (68,3%) out of 164 outlets, alcoholic cocktails — in 71 (45,2%) out of 57 outlets. The average lowest selling price of vodka is 255,9±62,2 RUB (minimum — 230 RUB), wine — 180,2±89,3 RUB (minimum — 110 rubles), beer — 51,2±15,5 RUB (minimum — 33 rubles), alcoholic cocktails — 58,9±15,4 RUB (minimum — 37 rubles). In addition, 27 (10,5%) of 256 supermarkets with a liquor section (minimum distance of 64m) are located <100 m from educational institutions, as well as 10 (5,4%) out of 183 individual stores specializing in the alcohol sale (minimum distance of 50 m).

Conclusion. The results obtained with the help of the developed tool can be used as arguments for strengthening monitoring of compliance and making changes to the current legislation that restricts the availability of tobacco and alcohol products. The use of the developed tool will make it possible using evidence to make informed decisions in the development and implementation of public health programs at the municipal level.

Patterns of Perceived Indoor Environment in Danish Homes

The indoor environment is composed of several exposures existing simultaneously. Therefore, it might be useful to combine exposures into common combined measures when used to assess the association with health. The aim of our study was to identify patterns of the perceived indoor environment. Data from the Danish Health and Morbidity Survey in the year 2000 were used. The perceived indoor environment was assessed using a questionnaire (e.g., annoyances from noise, draught, and stuffy air; 13 items in total). Factor analysis was used to explore the structure of relationships between these 13 items. Furthermore, groups of individuals with similar perceived indoor environment were identified using latent class analysis. A total of 16,688 individuals ≥16 years participated. Their median age was 46 years. Four factors were extracted from the factor analysis. The factors were characterized by: (1) a mixture of items, (2) temperature, (3) traffic, and (4) neighbor noise. Moreover, three groups of individuals sharing the same perception of their indoor environment were identified. They were characterized by: a low (n = 14,829), moderate (n = 980), and large number of annoyances (n = 879). Observational studies need to take this correlation and clustering of perceived annoyances into account when studying associations between the indoor environment and health.

Multiple Long-Term Conditions (MLTC) and the Environment: A Scoping Review

Background: Multiple Long Term conditions (MLTC) are a major health care challenge associated with high service utilisation and expenditure. Once established, the trajectory to an increased number and severity of conditions, hospital admission, increased social care need and mortality is multifactorial. The role of wider environmental determinants in the MLTC sequelae is unclear. Aim: the aim of this review was to summarise and collate existing evidence on environmental determinants on established MLTC. Methods: comprehensive search of Medline, Embase, Cochrane, CINAHL and Bielefeld Academic Search Engine (BASE), from inception to 4th June 2022 in addition to grey literature. Two authors independently screened and extracted papers. Disagreements were resolved with a third author. Results: searches yielded 9079 articles, 12 of which met the review's inclusion criteria. Evidence of correlations between some environmental determinants and increased or decreased risks of MLTC were found, including the quality of internal housing/living environments, exposure to airborne environmental hazards and a beneficial association with socially cohesive, accessible and greener neighbourhood environments. Conclusions: The majority of the 12 included papers focused on the built and social environments. The review uncovered very limited evidence, indicating a need for further research to understand the role of environmental determinants in MLTC.

Conceptualizing the Socio-Built Environment: An Expanded Theoretical Framework to Promote a Better Understanding of Risk for Nonmedical Opioid Overdose Outcomes in Urban and Non-Urban Settings

Nonmedical opioid (NMO) use has been linked to significant increases in rates of NMO morbidity and mortality in non-urban areas. While there has been a great deal of empirical evidence suggesting that physical features of built environments represent strong predictors of drug use and mental health outcomes in urban settings, there is a dearth of research assessing the physical, built environment features of non-urban settings in order to predict risk for NMO overdose outcomes. Likewise, there is strong extant literature suggesting that social characteristics of environments also predict NMO overdoses and other NMO use outcomes, but limited research that considers the combined effects of both physical and social characteristics of environments on NMO outcomes. As a result, important gaps in the scientific literature currently limit our understanding of how both physical and social features of environments shape risk for NMO overdose in rural and suburban settings and therefore limit our ability to intervene effectively. In order to foster a more holistic understanding of environmental features predicting the emerging epidemic of NMO overdose, this article presents a novel, expanded theoretical framework that conceptualizes "socio-built environments" as comprised of (a) environmental characteristics that are applicable to both non-urban and urban settings and (b) not only traditional features of environments as conceptualized by the extant built environment framework, but also social features of environments. This novel framework can help improve our ability to identify settings at highest risk for high rates of NMO overdose, in order to improve resource allocation, targeting, and implementation for interventions such as opioid treatment services, mental health services, and care and harm reduction services for people who use drugs.

A population-based retrospective study of the modifying effect of urban blue space on the impact of socioeconomic deprivation on mental health, 2009-2018

The incidence of mental health disorders in urban areas is increasing and there is a growing interest in using urban blue spaces (urban waterways, canals, lakes, ponds, coasts, etc.) as a tool to manage and mitigate mental health inequalities in the population. However, there is a dearth of longitudinal evidence of the mechanisms and impact of blue spaces on clinical markers of mental health to support and inform such interventions. We conducted a 10-year retrospective study, following STROBE guidelines, using routinely collected population primary care health data within the National Health Service (NHS) administrative area of Greater Glasgow and Clyde for the North of Glasgow city area. We explored whether living near blue space modifies the negative effect of socio-economic deprivation on mental health during the regeneration of an urban blue space (canal) from complete dereliction and closure. A total of 132,788 people (65,351 female) fulfilling the inclusion criteria were entered in the analysis. We established a base model estimating the effect of deprivation on the risk of mental health disorders using a Cox proportional hazards model, adjusted for age, sex and pre-existing comorbidities. We then investigated the modifying effect of living near blue space by computing a second model which included distance to blue space as an additional predicting variable and compared the results to the base model. Living near blue space modified the risk of mental health disorders deriving from socio-economic deprivation by 6% (hazard ratio 2.48, 95% confidence interval 2.39–2.57) for those living in the most deprived tertile (T1) and by 4% (hazard ratio 1.66, 95% confidence interval 1.60–1.72) for those in the medium deprivation tertile (T2). Our findings support the notion that living near blue space could play an important role in reducing the burden of mental health inequalities in urban populations.

Urban Air Pollution, Urban Heat Island and Human Health: A Review of the Literature

Many cities of the world suffer from air pollution because of poor planning and design and heavy traffic in rapidly expanding urban environments. These conditions are exacerbated due to the Urban Heat Island (UHI) effect. While there have been studies linking the built environment and air pollution with health, they have ignored the aggravating role of UHI. The past urban planning literature in this field has also ignored the science of materials, vehicles and air pollution, and technological solutions for reducing cumulative health impacts of air pollution and UHI. Air Pollution, built environment and human health are complex discussion factors that involve several different fields. The built environment is linked with human health through opportunities of physical activity and air quality. Recent planning literature focuses on creating compact and walkable urban areas dotted with green infrastructure to promote physical activity and to reduce vehicle emission-related air pollution. Reduced car use leading to reduced air pollution and UHI is implied in the literature. The literature from technology fields speaks to the issue of air pollution directly. Zero emission cars, green infrastructure and building materials that absorb air pollutants and reduce UHI fall within this category. This paper identifies main themes in the two streams of urban air pollution and UHI that impact human health and presents a systematic review of the academic papers, policy documents, reports and features in print media published in the last 10–20 years.

Microflora Influence: The Aquatic Environment Changes Grouping Risk and Development Speed of Toad Tadpoles

In addition to habitat loss and fragmentation, behavioral traits and the deterioration of water environments also contribute to the local extinction of amphibians. Abundant microflora in urban ponds may cause fatal diseases, whereas symbiotic bacteria may protect the host from pathogens; these effects may vary with group size. In this study, I monitored the growth of Japanese common toad (Bufo japonicus) larvae in Tokyo using three different group sizes: 1 (solitary), 2 (pair), and 15. Although there was no genetic bias in the major histocompatibility complex (MHC) class II genes or microsatellite loci to the survival of the larvae, the mortality risk of the larvae reared in pond water was higher than that of those reared in tap water. According to the survival analysis, the risk was more significant when the group size was 15. This result would be unwelcomed for the B. japonicus tadpoles, which have habits of social aggregation. Furthermore, larval metamorphosis took longer to complete in pond than tap water without any difference in body length or mass. These findings provide fundamental insight into the impact of the aquatic environment and the effect of the group size on animal health and conservation.

The Effect of Built Environment on Physical Health and Mental Health of Adults: A Nationwide Cross-Sectional Study in China

At present, there is a lack of research examining the relationships between the built environment and health status from a social epidemiological perspective. With this in mind, the present study aimed to explore the construct validity of housing/neighborhood conditions and evaluate the associations between the built environment and self-rated health among Chinese residents. To conduct the analysis, data from 4906 participants were derived from the 2016 China Labor-force Dynamics Survey (CLDS). Specifically, we used exploratory factor analysis to identify construct of housing/neighborhood factors and performed principal component regression (PCR) to assess the relationship between the built environment and both self-rated physical health and mental health. This process identified five common factors that corresponded to the built environment, including housing affordability, housing quality, neighborhood services, neighborhood physical environment, and perceived environment. The regression results suggested that housing affordability was negatively related to health status. Meanwhile, the services, physical environment, and perceived environment of neighborhoods were related to positive health outcomes. The influence of housing on health exhibits group heterogeneity: respondents in the 41 to 65 age group were most vulnerable to poor built environments. Whilst the results indicated that housing factors and neighborhood conditions were related to health outcomes, their influence varied across different age groups. Future interventions should be intentionally designed to target housing affordability and neighborhood factors, which may include the provision of housing assistance programs and planning layouts.

Modelling geographical heterogeneity of diabetes prevalence and socio-economic and built environment determinants in Saudi City - Jeddah

Type-2 diabetes is a growing lifestyle disease mainly due to increasing physical inactivity but also associated with various other variables. In Saudi Arabia, around 58.5% of the population is deemed to be physically inactive. Against this background, this study attempts explore the spatial heterogeneity of Type-2 diabetes prevalence in Jeddah and to estimate various socio-economic and built environment variables contributing to the prevalence of this disease based on modelling by ordinary least squares (OLS), weighted regression (GWR) and multi-scale geographically weighted (MGWR). Our OLS results suggest that income, population density, commercial land use and Saudi population characteristics are statistically significant for Type-2 diabetes prevalence. However, by the GWR model, income, commercial land use and Saudi population characteristics were significantly positive while population density was significantly negative in this model for 70.6%, 9.1%, 26.6% and 58.7%, respectively, out of 109 districts investigated; by the MGWR model, the corresponding results were 100%, 22%, 100% and 100% of the districts. With the given data, the corrected Akaike information criterion (AICc), the adjusted R2, the log-likelihood and the residual sum of squares (RSS) indices demonstrated that the MGWR model outperformed the GWR and OLS models explaining 29% more variance than the OLS model, and 10.2% more than the GWR model. These results support the development of evidence-based policies for the spatial allocation of health associated resources for the control of Type-2 diabetes in Jeddah and other cities in the Arabian Gulf.

The first report on the prevalence of soil-transmitted helminth infections and associated risk factors among traditional pig farmers in Bali Province, Indonesia

Background and Aim:

Pigs are the main livestock commodity in Bali Province, Indonesia, where traditional farming practices are widely used. Traditional pig farmers are often closely associated with poverty and a perceived lack of knowledge regarding health and hygiene. Data on soil-transmitted helminthiasis (STH) and risk factors associated with STH worm infection among traditional pig farmers in Bali were previously unavailable. This study aimed to analyze the prevalence and risk factors for STH infections among traditional pig farmers in Bali Province, Indonesia.

Materials and Methods:

This study involved the fecal examination of 238 traditional pig farmers from all areas of Bali Province in Indonesia. In addition, several pig feces samples were combined into one pooled sample belonging to each farm. All fresh fecal samples were stored in a 5% formaldehyde solution before being analyzed using concentration flotation techniques. Subsequently, risk factors were determined through an interview and a questionnaire. The odds ratio (OR) and Chi-square tests were used to determine the risk factors associated with STH infections.

Results:

The result showed that there was a high prevalence of STH infections among traditional pig farmers and pig farms in Bali, with rates of 21.8% and 76.5%, respectively. This could be due to risk factors, such as personal hygiene (OR: 5.756; confidence interval [CI]: 2.96-11.193; p=0.00), sanitation (OR: 1.914; CI: 1.024-3.576; p=0.042), education level (OR: 7.579; CI: 2.621-21.915; p=0.00), household income (OR: 2.447; CI: 1.122-5.338; p=0.025), and occupation (OR: 2.95; CI: 1.356-6.415; p=0.006).

Conclusion:

The infections seen in farmers were distributed among hookworm, Ascaris spp., and Trichuris spp., at 15.1%, 9.2%, and 4.2%, respectively. The risk factors associated with infections of STH and Ascaris spp. were personal hygiene, home sanitation, education level, household income, and having a primary occupation as a traditional pig farmer. In contrast, personal hygiene, education level, and primary occupation were the only risk factors for hookworm infection, while personal hygiene and home sanitation were the risk factors associated with Trichuris spp. infection. The limitation of this study was that the number of samples was relatively small due to the difficulty of obtaining stool samples from traditional pig farmers, with many individuals refusing to provide their stool for inspection. We suggest that future research focus on identifying the species of worms that infect traditional pig farmers and to better identify the zoonotic link of STH transmission from pigs to humans.

Early life adversity, inflammation, and immune function: An initial test of adaptive response models of immunological programming

Much research indicates that exposure to early life adversity (ELA) predicts chronic inflammatory activity, increasing one's risk of developing diseases of aging later in life. Despite its costs, researchers have proposed that chronic inflammation may be favored in this context because it would help promote immunological vigilance in environments with an elevated risk of infection and injury. Although intuitively appealing, the assumption that exaggerated inflammatory activity predicts favorable immunological outcomes among those exposed to ELA has not been tested. Here, we seek to address this gap, examining the links between exposure to ELA, inflammation, and immune function. Consistent with others' work, results revealed that those from low socioeconomic status (SES) childhood environments exhibited exaggerated unstimulated inflammatory activity relative to what was observed among those from higher SES childhood environments. Further, results revealed that - although levels of inflammation predicted the magnitude of immunological responses in those from higher SES backgrounds - for those who grew up in low SES environments, higher levels of inflammation were unrelated to the magnitude of immunological responses. Results suggest that exaggerated inflammatory activity in the context of ELA may not predict improved ability to manage acute immunological threats.

Environmental Factors Influencing COVID-19 Incidence and Severity

Emerging evidence supports a link between environmental factors-including air pollution and chemical exposures, climate, and the built environment-and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission and coronavirus disease 2019 (COVID-19) susceptibility and severity. Climate, air pollution, and the built environment have long been recognized to influence viral respiratory infections, and studies have established similar associations with COVID-19 outcomes. More limited evidence links chemical exposures to COVID-19. Environmental factors were found to influence COVID-19 through four major interlinking mechanisms: increased risk of preexisting conditions associated with disease severity; immune system impairment; viral survival and transport; and behaviors that increase viral exposure. Both data and methodologic issues complicate the investigation of these relationships, including reliance on coarse COVID-19 surveillance data; gaps in mechanistic studies; and the predominance of ecological designs. We evaluate the strength of evidence for environment-COVID-19 relationships and discuss environmental actions that might simultaneously address the COVID-19 pandemic, environmental determinants of health, and health disparities.

Health Care Disparities in the COVID-19 Pandemic in the United States: A Focus on Obstetrics

The influence of social determinants of health on disease dynamics and outcomes has become increasingly clear, making them a prime target of investigation and mitigation efforts. The obstetric population is uniquely positioned to provide insight into the health inequities exacerbated by the coronavirus disease 2019 pandemic given their susceptibility to infectious disease morbidity and frequent interactions with the health care system, which provide opportunities for ascertainment of disease incidence and severity. This review summarizes the data on disparities identified in the US obstetric population during the coronavirus disease 2019 pandemic as they relate to race and ethnicity, built environment, insurance status, language, and immigration status.

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.

Socioeconomic Determinants of Health and Their Unequal Distribution in Poland

The purpose of this study is to identify inequities in the distribution of socioeconomic determinants of health within Poland and their impact on the health status of Poles, as measured by mortality rate. We hypothesised that (1) there are inequities in the socioeconomic characteristics within geographically defined population groups and (2) some socioeconomic determinants of health have a particularly strong impact on the health status of Poles. Poland is administratively divided into three levels: voivodeships, powiats and gminas. We used a dataset covering all 380 powiats in Poland for the year 2018. We employed a two-stage nested Theil index and Herfindahl–Hirschman Index. In order to identify which of these determinants has the strongest impact on health, we conducted a regression analysis. The study revealed some inequities in the distribution of socioeconomic determinants of health. The mortality rate can be partly understood from variations within voivodeships in the distribution of health determinants. Important national inequalities were found in the case of two determinants, which simultaneously proved their significant impact on Poles’ health in the regression analysis. Thus, type of employment and access to modern infrastructure should be of particular concern for public authorities.

Parental Preconception Exposures to Outdoor Neighbourhood Environments and Adverse Birth Outcomes: A Protocol for a Scoping Review and Evidence Map

Parental preconception exposures to built and natural outdoor environments could influence pregnancy and birth outcomes either directly, or via a range of health-related behaviours and conditions. However, there is no existing review summarising the evidence linking natural and built characteristics, such as air and noise pollution, walkability, greenness with pregnancy and birth outcomes. Therefore, the planned scoping review aims to collate and map the published literature on parental preconception exposures to built and natural outdoor environments and adverse pregnancy and birth outcomes. We will search electronic databases (MEDLINE, EMBASE, Scopus) to identify studies for inclusion. Studies will be included if they empirically assess the relationship between maternal and paternal preconception exposures to physical natural and built environment features that occur outdoors in the residential neighbourhood and adverse pregnancy and birth outcomes. Two reviewers will independently screen titles and abstracts, and then the full text. Data extraction and assessment of study quality will be performed by one researcher and checked by a second researcher. Results will be summarised in a narrative synthesis, with additional summaries presented as tables and figures. The scoping review will be disseminated via a peer-reviewed publication, at academic conferences, and published on a website.

The impact of school exclusion zone planning guidance on the number and type of food outlets in an English local authority: A longitudinal analysis

The use of planning policy to manage and create a healthy food environment has become a popular policy tool for local governments in England. To date there has been no evaluation of their short-term impact on the built environment. We assess if planning guidance restricting new fast food outlets within 400 m of a secondary school, influences the food environment in the local authority of Newcastle Upon Tyne, UK. We have administrative data on all food outlets in Newcastle 3 years pre-intervention 2012-2015, the intervention year 2016, and three years' post-intervention 2016-2019. We employ a difference-in-difference approach comparing postcodes within the school fast food outlet exclusion zone to those outside the fast-food exclusion zones. In the short term (3 years), planning guidance to limit the number of new fast-food outlets in a school exclusion zone did not have a statistically significant impact on the food environment when compared with a control zone.

Identifying the space-time patterns of COVID-19 risk and their associations with different built environment features in Hong Kong

Identifying the space-time patterns of areas with a higher risk of transmission and the associated built environment and demographic characteristics during the COVID-19 pandemic is critical for developing targeted intervention measures in response to the pandemic. This study aims to identify areas with a higher risk of COVID-19 transmission in different periods in Hong Kong and analyze the associated built environment and demographic factors using data of individual confirmed cases. We detect statistically significant space-time clusters of COVID-19 at the Large Street Block Group (LSBG) level in Hong Kong between January 23 and April 14, 2020. Two types of high-risk areas are identified (residences of and places visited by confirmed cases) and two types of cases (imported and local cases) are considered. The demographic and built environment features for the identified high-risk areas are further examined. The results indicate that high transport accessibility, dense and high-rise buildings, a higher density of commercial land and higher land-use mix are associated with a higher risk for places visited by confirmed cases. More green spaces, higher median household income, lower commercial land density are linked to a higher risk for the residences of confirmed cases. The results in this study not only can inform policymakers to improve resource allocation and intervention strategies but also can provide guidance to the public to avoid conducting high-risk activities and visiting high-risk places.

Population density and basic reproductive number of COVID-19 across United States counties

The basic reproductive number (R₀) is a function of contact rates among individuals, transmission probability, and duration of infectiousness. We sought to determine the association between population density and R₀ of SARS-CoV-2 across U.S. counties. We conducted a cross-sectional analysis using linear mixed models with random intercept and fixed slopes to assess the association of population density and R₀, and controlled for state-level effects using random intercepts. We also assessed whether the association was differential across county-level main mode of transportation percentage as a proxy for transportation accessibility, and adjusted for median household income. The median R₀ among the United States counties was 1.66 (IQR: 1.35–2.11). A population density threshold of 22 people/km² was needed to sustain an outbreak. Counties with greater population density have greater rates of transmission of SARS-CoV-2, likely due to increased contact rates in areas with greater density. An increase in one unit of log population density increased R₀ by 0.16 (95% CI: 0.13 to 0.19). This association remained when adjusted for main mode of transportation and household income. The effect of population density on R₀ was not modified by transportation mode. Our findings suggest that dense areas increase contact rates necessary for disease transmission. SARS-CoV-2 R₀ estimates need to consider this geographic variability for proper planning and resource allocation, particularly as epidemics newly emerge and old outbreaks resurge.

Built Environment and HIV Linkage to Care in Rural South Africa

Background

We assessed built environment (residential density, landuse mix and aesthetics) and HIV linkage to care (LTC) among 1,681 (18–49 years-old) residents of 15 Mpumalanga villages, South Africa.

Methods

Multilevel models (linear-binomial) were used for the association between built environment, measured using NEWS for Africa, and LTC from a clinical database of 9 facilities (2015–2018). Additionally, we assessed effect-measure modification by universal test-and-treat policy (UTT).

Results

We observed, a significant association in the adjusted 3-month probability of LTC for residential density (risk difference (RD)%: 5.6, 95%CI: 1.2–10.1), however, no association for land-use mix (RD%: 2.4, 95%CI: −0.4, 5.2) and aesthetics (RD%: −1.2, 95%CI: −4.5–2.2). Among those diagnosed after UTT, residents of high land-use villages were more likely to link-to-care than those of low land-use villages at 12 months (RD%: 4.6, 95%CI: 1.1–8.1, p < 0.04), however, not at 3 months (RD%: 3.0, 95%CI: −2.1–8.0, p > 0.10).

Conclusion

Findings suggest, better built environment conditions (adequate infrastructure, proximity to services etc.) help facilitate LTC. Moreover, UTT appears to have a protective effect on LTC.

The Cognitive-Emotional Design and Study of Architectural Space: A Scoping Review of Neuroarchitecture and Its Precursor Approaches

Humans respond cognitively and emotionally to the built environment. The modern possibility of recording the neural activity of subjects during exposure to environmental situations, using neuroscientific techniques and virtual reality, provides a promising framework for future design and studies of the built environment. The discipline derived is termed "neuroarchitecture". Given neuroarchitecture's transdisciplinary nature, it progresses needs to be reviewed in a contextualised way, together with its precursor approaches. The present article presents a scoping review, which maps out the broad areas on which the new discipline is based. The limitations, controversies, benefits, impact on the professional sectors involved, and potential of neuroarchitecture and its precursors' approaches are critically addressed.

Coronavirus disease 2019 (COVID-19) mortality and neighborhood characteristics in Chicago

Purpose

To describe coronavirus disease 2019 (COVID-19) mortality in Chicago during the spring of 2020 and identify at the census-tract level neighborhood characteristics that were associated with higher COVID-19 mortality rates.

Methods

Using Poisson regression and regularized linear regression (elastic net), we evaluated the association between neighborhood characteristics and COVID-19 mortality rates in Chicago through July 22 (2514 deaths across 795 populated census tracts).

Results

Black residents (31% of the population) accounted for 42% of COVID-19 deaths. Deaths among Hispanic/Latino residents occurred at a younger age (63 years, compared with 71 for white residents). Regarding residential setting, 52% of deaths among white residents occurred inside nursing homes, compared with 35% of deaths among black residents and 17% among Hispanic/Latino residents. Higher COVID-19 mortality was seen in neighborhoods with heightened barriers to social distancing and low health insurance coverage. Neighborhoods with a higher percentage of white and Asian residents had lower COVID-19 mortality. The associations differed by race, suggesting that neighborhood context may be most tightly linked to COVID-19 mortality among white residents.

Conclusions

We describe communities that may benefit from supportive services and identify traits of communities that may benefit from targeted campaigns for prevention and testing to prevent future deaths from COVID-19.

Investigating the Relationship between the Built Environment and Relative Risk of COVID-19 in Hong Kong

Understanding the relationship between the built environment and the risk of COVID-19 transmission is essential to respond to the pandemic. This study explores the relationship between the built environment and COVID-19 risk using the confirmed cases data collected in Hong Kong. Using the information on the residential buildings and places visited for each case from the dataset, we assess the risk of COVID-19 and explore their geographic patterns at the level of Tertiary Planning Unit (TPU) based on incidence rate (R1) and venue density (R2). We then investigate the associations between several built-environment variables (e.g., nodal accessibility and green space density) and COVID-19 risk using global Poisson regression (GPR) and geographically weighted Poisson regression (GWPR) models. The results indicate that COVID-19 risk tends to be concentrated in particular areas of Hong Kong. Using the incidence rate as an indicator to assess COVID-19 risk may underestimate the risk of COVID-19 transmission in some suburban areas. The GPR and GWPR models suggest a close and spatially heterogeneous relationship between the selected built-environment variables and the risk of COVID-19 transmission. The study provides useful insights that support policymakers in responding to the COVID-19 pandemic and future epidemics.

Reliability of an Assessment Tool and Outcomes of a Comprehensive Worksite Wellness Intervention

OBJECTIVE

The purpose of this study was to determine the reliability of a comprehensive worksite-level assessment and identify which worksite wellness best practices were implemented following a workshop.

METHODS

Kansas worksites attended a WorkWell Kansas Phase I workshop from 2012 through 2014 and completed a 155-item assessment before the workshop and 1 year later. Cronbach alpha measured the internal consistency of the WorkWell KS Phase I Assessment, and McNemar test assessed differences in proportions from baseline to follow-up.

RESULTS

Two hundred eighty five worksites completed a baseline assessment, of which, 109 completed the follow-up assessment (32%). The internal consistency of the instrument was 0.96, and worksites reported significant improvements at follow-up from baseline for nine variables.

CONCLUSIONS

Improvements predominantly included creating a wellness committee, assessing needs, and developing goals. There was a lack of policy and systems level improvements at the worksite.

Using 164 Million Google Street View Images to Derive Built Environment Predictors of COVID-19 Cases

The spread of COVID-19 is not evenly distributed. Neighborhood environments may structure risks and resources that produce COVID-19 disparities. Neighborhood built environments that allow greater flow of people into an area or impede social distancing practices may increase residents' risk for contracting the virus. We leveraged Google Street View (GSV) images and computer vision to detect built environment features (presence of a crosswalk, non-single family home, single-lane roads, dilapidated building and visible wires). We utilized Poisson regression models to determine associations of built environment characteristics with COVID-19 cases. Indicators of mixed land use (non-single family home), walkability (sidewalks), and physical disorder (dilapidated buildings and visible wires) were connected with higher COVID-19 cases. Indicators of lower urban development (single lane roads and green streets) were connected with fewer COVID-19 cases. Percent black and percent with less than a high school education were associated with more COVID-19 cases. Our findings suggest that built environment characteristics can help characterize community-level COVID-19 risk. Sociodemographic disparities also highlight differential COVID-19 risk across groups of people. Computer vision and big data image sources make national studies of built environment effects on COVID-19 risk possible, to inform local area decision-making.

Impact of the Built Environment and the Neighborhood in Promoting the Physical Activity and the Healthy Aging in Older People: An Umbrella Review

(1) Background: The aim of this study is to establish which specific elements of the built environment can contribute to improving the physical activity of self-sufficient, noninstitutionalized and living in the city adults > 65 years. (2) Methods: An extensive literature search was conducted in several database. Umbrella review methodology was used to include the reviews that presented a sufficient methodological quality. (3) Results: Eleven reviews were included. The elements positively associated with physical activity in older adults were: walkability; residential density/urbanization; street connectivity; land-use mix-destination diversity; overall access to facilities, destinations and services; pedestrian-friendly infrastructures; greenery and aesthetically pleasing scenery; high environmental quality; street lighting; crime-related safety; traffic-related safety. The elements that were negatively associated with physical activity were: poor pedestrian access to shopping centers; poor pedestrian-friendly infrastructure and footpath quality; barriers to walking/cycling; lack of aesthetically pleasing scenery; crime-related unsafety; unattended dogs; inadequate street lighting and upkeep; traffic; littering, vandalism, decay; pollution; noise. (4) Conclusions: Evidence shows that specific elements of the built environment can contribute to promoting older people’s physical activity. The city restructuring plans should take into consideration these factors.

Cardiometabolic Health: Key in Reducing Adverse COVID-19 Outcomes

Whilst current public health measures focused on good hygiene practices and limiting person-to-person transmission contribute effectively in managing the COVID-19 pandemic, they will not prevent all individuals from becoming infected. Thus, it is of importance to explore what individuals could do to mitigate adverse outcomes. The value of beneficial health behaviours and a healthy lifestyle to improve immune functioning and lower adverse consequences of COVID-19 are increasingly being emphasized. Here we discuss seven key health behaviours and corresponding recommendations that may assist in reducing unfavourable COVID-19 outcomes.

A multimethod approach for county-scale geospatial analysis of emerging infectious diseases: a cross-sectional case study of COVID-19 incidence in Germany

Background

As of 13 July 2020, 12.9 million COVID-19 cases have been reported worldwide. Prior studies have demonstrated that local socioeconomic and built environment characteristics may significantly contribute to viral transmission and incidence rates, thereby accounting for some of the spatial variation observed. Due to uncertainties, non-linearities, and multiple interaction effects observed in the associations between COVID-19 incidence and socioeconomic, infrastructural, and built environment characteristics, we present a structured multimethod approach for analysing cross-sectional incidence data within in an Exploratory Spatial Data Analysis (ESDA) framework at the NUTS3 (county) scale.

Methods

By sequentially conducting a geospatial analysis, an heuristic geographical interpretation, a Bayesian machine learning analysis, and parameterising a Generalised Additive Model (GAM), we assessed associations between incidence rates and 368 independent variables describing geographical patterns, socioeconomic risk factors, infrastructure, and features of the build environment. A spatial trend analysis and Local Indicators of Spatial Autocorrelation were used to characterise the geography of age-adjusted COVID-19 incidence rates across Germany, followed by iterative modelling using Bayesian Additive Regression Trees (BART) to identify and measure candidate explanatory variables. Partial dependence plots were derived to quantify and contextualise BART model results, followed by the parameterisation of a GAM to assess correlations.

Results

A strong south-to-north gradient of COVID-19 incidence was identified, facilitating an empirical classification of the study area into two epidemic subregions. All preliminary and final models indicated that location, densities of the built environment, and socioeconomic variables were important predictors of incidence rates in Germany. The top ten predictor variables’ partial dependence exhibited multiple non-linearities in the relationships between key predictor variables and COVID-19 incidence rates. The BART, partial dependence, and GAM results indicate that the strongest predictors of COVID-19 incidence at the county scale were related to community interconnectedness, geographical location, transportation infrastructure, and labour market structure.

Conclusions

The multimethod ESDA approach provided unique insights into spatial and aspatial non-stationarities of COVID-19 incidence in Germany. BART and GAM modelling indicated that geographical configuration, built environment densities, socioeconomic characteristics, and infrastructure all exhibit associations with COVID-19 incidence in Germany when assessed at the county scale. The results suggest that measures to implement social distancing and reduce unnecessary travel may be important methods for reducing contagion, and the authors call for further research to investigate the observed associations to inform prevention and control policy.

Associations Between Built Environment, Neighborhood Socioeconomic Status, and SARS-CoV-2 Infection Among Pregnant Women in New York City

This cross-sectional study investigates associations of residential building characteristics and markers of neighborhood socioeconomic status (SES) with screen-detected SARS-CoV-2 prevalence among pregnant women delivering in 2 New York City hospitals.

COVID-19 Could Leverage a Sustainable Built Environment

The health system’s response to the COVID-19 pandemic has involved research into diagnoses and vaccines, but primarily it has required specific treatments, facilities and equipment, together with the control of individual behaviour and a period of collective confinement. The aim of this particular research, therefore, is to discover whether COVID-19 is capable of changing the built environment (BE) and leveraging specific solutions for sustainable buildings or urban areas. Some historical reviews of infectious pandemics have highlighted the development of new solutions in the BE as an additional contribution towards preventing the spread of infection. The BE has an important role to play in supporting public health measures and reducing the risk of infections. The review of potential COVID-19 measures shows the existence of well-referenced solutions, ranging from incremental alterations (organisation of spaces, erection of physical barriers) to structural alterations (windows, balconies) with different timeframes and scales (ranging from changes in building materials to the design of urban areas). A critical exploratory assessment makes it possible to identify measures that may help not only to reduce the risk of COVID-19 transmission (or even prevent it), but also to increase resilience, improve air quality and lower energy requirements or the use of materials, and thus potentially increase the sustainability of the BE. COVID-19 measures challenge us to rethink buildings and urban areas and potentially leverage sustainable BE solutions with win-win outcomes (minimalist design and other solutions). The specific composition of this set of measures must, however, be further researched.